美国成年艾滋病毒感染者的癌症发病率和趋势

IF 20.1 1区医学 Q1 Biochemistry, Genetics and Molecular Biology

Jama Oncology Pub Date : 2025-06-12 DOI:10.1001/jamaoncol.2025.1589

Cameron B Haas, Jennifer K McGee-Avila, Qianlai Luo, Ruth M Pfeiffer, Susan Gershman, Sai Cherala, Colby Cohen, Analise Monterosso, Natalie Archer, Tabassum Z Insaf, Eric A Engels, Meredith S Shiels

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Comparing years 2015 to 2019 to years 2010 to 2014, incidence of diffuse large B-cell lymphoma (DLBCL) decreased 23% (IRR, 0.77; 95% CI, 0.70-0.84), Kaposi sarcoma (KS) decreased 24% (IRR, 0.76; 95% CI, 0.69-0.84), Hodgkin lymphoma decreased 25% (IRR, 0.75; 95% CI, 0.65-0.86), and cancers of the lung decreased 17% (IRR, 0.83; 95% CI, 0.77-0.90) and liver decreased 25% (IRR, 0.75; 95% CI, 0.67-0.84). Among people with HIV aged 70 to 84 years, IRs were highest for cancers of the prostate (448.01; 95% CI, 404.26-495.20), lung (269.79; 95% CI, 240.86-301.24), female breast (202.29; 95% CI, 155.79-258.32), liver (82.82; 95% CI, 67.16-101.03), and colon (107.57; 95% CI, 89.61-128.08), exceeding the IRs for DLBCL (41.83; 95% CI, 30.95-55.31) and KS (15.37; 95% CI, 9.11-24.29). 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引用次数: 0

摘要

重要性：由于过去20年来抗逆转录病毒治疗的改进，艾滋病毒感染者的寿命延长了。目前艾滋病毒感染者中特定年龄的癌症风险估计可能为这一人群的癌症预防和临床指南提供信息。目的：利用基于人群的HIV和癌症登记联系来估计癌症发病率（IRs）。设计、环境和参与者：这项基于人群的队列研究使用了2001年至2019年美国12个州、华盛顿特区和波多黎各的数据。在2023年10月至2024年12月期间进行的艾滋病毒/艾滋病癌症匹配研究中，艾滋病毒感染者和普通人群被纳入分析。主要结局和测量方法：使用调整后的泊松回归计算历期（2001 - 2004年、2005 - 2009年、2010 - 2014年和2015 - 2019年）的年龄标准化IRs（每100,000 000人年）和历期的发病率比（IRRs）。对2010年至2014年和2015年至2019年的标准化发病率（SIRs）进行了估计，并对2010年至2019年的年龄组特定癌症发病率和SIRs进行了估计。结果：该分析包括847 107名HIV感染者中的720万人年（男性为530万人年[73%]）。2015 - 2019年与2010 - 2014年相比，弥漫性大b细胞淋巴瘤（DLBCL）的发病率下降了23% (IRR, 0.77；95% CI, 0.70-0.84)，卡波西肉瘤（KS）减少24% (IRR, 0.76；95% CI, 0.69-0.84)，霍奇金淋巴瘤下降25% (IRR, 0.75；95% CI, 0.65-0.86)，肺癌减少17% (IRR, 0.83；95% CI, 0.77-0.90)，肝脏下降25% (IRR, 0.75；95% ci, 0.67-0.84)。在70至84岁的HIV感染者中，前列腺癌的IRs最高(448.01；95% CI, 404.26-495.20)，肺(269.79；95% CI, 240.86-301.24)，女性乳房(202.29；95% CI, 155.79-258.32)，肝脏(82.82；95% CI, 67.16-101.03)和结肠(107.57；95% CI, 89.61-128.08)，超过DLBCL的ir (41.83；95% CI, 30.95-55.31)和KS (15.37；95% ci, 9.11-24.29)。从2015年到2019年，艾滋病毒感染者罹患几种癌症的风险仍然显著升高，包括KS (SIR, 213.87；95% CI, 198.81-229.73)，霍奇金淋巴瘤(SIR, 6.29；95% ci, 5.68-6.94), DLBCL (sir, 5.25；95% CI, 5.25-6.01)，肛门癌(SIR, 17.07；95% CI, 16.01-18.17)，外阴(SIR, 11.40；95% CI, 9.60-13.44)，肝脏(SIR, 1.89；95% CI, 1.74-2.05)和肺(SIR, 1.59；95% ci, 1.51-1.68)。对于几乎所有这些癌症，SIRs都随着年龄的增长而显著下降。结论和相关性：在这项队列研究中，艾滋病毒感染者中癌症发病率和相对风险的显著下降表明艾滋病毒治疗和癌症预防的持续进展。随着艾滋病毒感染者进入癌症风险更高的年龄，这些估计可能有助于了解预防和早期发现癌症的优先事项。

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Cancer Incidence and Trends in US Adults With HIV.

Importance: People with HIV are living longer due to improvements in antiretroviral therapy over the last 2 decades. Current age-specific estimates of cancer risk among people with HIV may inform cancer prevention and clinical guidelines for this population.

Objective: To estimate cancer incidence rates (IRs) using a population-based linkage of HIV and cancer registries.

Design, setting, and participants: This population-based cohort study used data from 12 US states, Washington, DC, and Puerto Rico from 2001 to 2019. People with HIV and the general population in the HIV/AIDS Cancer Match Study were included in the analysis, which occurred between October 2023 and December 2024.

Main outcomes and measures: Age-standardized IRs (per 100 000 person-years) were calculated across calendar periods (2001 to 2004, 2005 to 2009, 2010 to 2014, and 2015 to 2019) and incidence rate ratios (IRRs) across calendar periods using adjusted Poisson regression. Standardized incidence ratios (SIRs) were estimated for 2010 to 2014 and 2015 to 2019, and age group-specific cancer incidence and SIRs were estimated for 2010 to 2019.

Results: The analysis included 7.2 million person-years among 847 107 people with HIV (5.3 million person-years among males [73%]). Comparing years 2015 to 2019 to years 2010 to 2014, incidence of diffuse large B-cell lymphoma (DLBCL) decreased 23% (IRR, 0.77; 95% CI, 0.70-0.84), Kaposi sarcoma (KS) decreased 24% (IRR, 0.76; 95% CI, 0.69-0.84), Hodgkin lymphoma decreased 25% (IRR, 0.75; 95% CI, 0.65-0.86), and cancers of the lung decreased 17% (IRR, 0.83; 95% CI, 0.77-0.90) and liver decreased 25% (IRR, 0.75; 95% CI, 0.67-0.84). Among people with HIV aged 70 to 84 years, IRs were highest for cancers of the prostate (448.01; 95% CI, 404.26-495.20), lung (269.79; 95% CI, 240.86-301.24), female breast (202.29; 95% CI, 155.79-258.32), liver (82.82; 95% CI, 67.16-101.03), and colon (107.57; 95% CI, 89.61-128.08), exceeding the IRs for DLBCL (41.83; 95% CI, 30.95-55.31) and KS (15.37; 95% CI, 9.11-24.29). From 2015 to 2019, risk remained significantly elevated in people with HIV for several cancer types, including KS (SIR, 213.87; 95% CI, 198.81-229.73), Hodgkin lymphoma (SIR, 6.29; 95% CI, 5.68-6.94), DLBCL (SIR, 5.25; 95% CI, 5.25-6.01), cancers of the anus (SIR, 17.07; 95% CI, 16.01-18.17), vulva (SIR, 11.40; 95% CI, 9.60-13.44), liver (SIR, 1.89; 95% CI, 1.74-2.05), and lung (SIR, 1.59; 95% CI, 1.51-1.68). For nearly all these cancers, SIRs significantly declined with increasing age.

Conclusions and relevance: In this cohort study, significant declines in the incidence and relative risk for cancers among people with HIV demonstrate continued progress in HIV treatment and cancer prevention. These estimates may provide insight into the priorities for prevention and early detection of cancer as the population of people with HIV enters ages with greater risk for cancer.

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来源期刊

Jama Oncology Medicine-Oncology

CiteScore

37.50

自引率

1.80%

发文量

423

期刊介绍： At JAMA Oncology, our primary goal is to contribute to the advancement of oncology research and enhance patient care. As a leading journal in the field, we strive to publish influential original research, opinions, and reviews that push the boundaries of oncology science. Our mission is to serve as the definitive resource for scientists, clinicians, and trainees in oncology globally. Through our innovative and timely scientific and educational content, we aim to provide a comprehensive understanding of cancer pathogenesis and the latest treatment advancements to our readers. We are dedicated to effectively disseminating the findings of significant clinical research, major scientific breakthroughs, actionable discoveries, and state-of-the-art treatment pathways to the oncology community. Our ultimate objective is to facilitate the translation of new knowledge into tangible clinical benefits for individuals living with and surviving cancer.