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首页> 外文期刊>Current opinion in HIV and AIDS >Factors contributing to risk for cancer among HIV-infected individuals, and evidence that earlier combination antiretroviral therapy will alter this risk
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Factors contributing to risk for cancer among HIV-infected individuals, and evidence that earlier combination antiretroviral therapy will alter this risk

机译：导致HIV感染者罹患癌症的风险的因素，以及早期联合抗逆转录病毒疗法将改变这种风险的证据

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摘要

PURPOSE OF REVIEW: To critically appraise recent published literature about factors associated with cancer risk likely to be influenced by combination antiretroviral therapy (cART) in HIV-infected individuals, and the potential of earlier cART initiation to reduce this risk. RECENT FINDINGS: Factors leading to increased risk of non-AIDS-defining malignancies (NADMs) in particular remain poorly understood. Immunodeficiency appears to be key, whereas evidence is emerging that a direct pro-oncogenic effect of HIV, activated inflammatory and coagulation pathways, and cART toxicity may also contribute. By reducing HIV replication, improving immune function, and limiting chronic inflammation, cART initiation at higher CD4 cell counts may, therefore, reduce NADM risk. However, cART only partly normalizes enhanced inflammation and coagulation seen during HIV infection and conflicting laboratory and epidemiological data have been reported as to whether (and how) cART affects NADM risk. Furthermore, secondary analyses of randomized controlled trials comparing early versus delayed cART initiation were inconclusive. SUMMARY: Continuous epidemiological surveillance is warranted to monitor trends in cancer incidence among HIV-infected individuals and to better understand the impact of earlier cART on NADM risk. The role of adjuvant anti-inflammatory or antithrombotic therapies to reduce cancer risk deserves further investigation.
机译：审查目的：严格评估最近发表的文献，这些文献涉及在HIV感染者中可能受到抗逆转录病毒联合疗法（cART）影响的与癌症风险相关的因素，以及更早开展cART降低这种风险的潜力。最近的发现：导致非艾滋病定义的恶性肿瘤（NADM）风险增加的因素仍然知之甚少。免疫缺陷似乎是关键，而越来越多的证据表明，HIV的直接致癌作用，激活的炎症和凝血途径以及cART毒性也可能起作用。通过减少HIV复制，改善免疫功能和限制慢性炎症，以较高CD4细胞计数启动cART可以降低NADM风险。但是，cART仅能部分标准化在HIV感染期间见到的炎症和凝血增强现象，并且关于cART是否（以及如何）影响NADM风险的实验室和流行病学数据已有报道。此外，比较早期和延迟cART启动的随机对照试验的次要分析尚无定论。摘要：有必要进行持续的流行病学监测，以监测HIV感染者中癌症发病率的趋势，并更好地了解早期cART对NADM风险的影响。辅助抗炎或抗血栓形成疗法在降低癌症风险中的作用值得进一步研究。

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