The interrelationship of smoking, CD4+ cell count, viral load and cancer in persons living with HIV

被引：10

作者：

Mocroft, A. ^{[1
]}

Petoumenos ^{[2
]}

Wit, F. ^{[3
]}

Vehreschild, J. J. ^{[4
]}

Guaraldi, G. ^{[5
]}

Miro, J. M. ^{[6
]}

Greenberg, L. ^{[1
]}

Oellinger, A. ^{[7
]}

Egle, A. ^{[8
]}

Guenthard, H. F. ^{[9
,10
]}

Bucher, H. C. ^{[11
,12
]}

De Wit, S. ^{[13
]}

Necsoi, C. ^{[13
]}

Castagna, A. ^{[14
]}

Spagnuolo, V ^{[14
]}

Monforte, A. D'Arminio ^{[15
]}

Reiss, P. ^{[3
]}

Chkhartishvili, N. ^{[16
]}

Bolokadze, N. ^{[16
]}

Hoy, J. ^{[17
,18
]}

Sonnenborg, A. ^{[19
]}

Svedhem, V ^{[19
]}

Bower, M. ^{[20
]}

Volny-Anne, A. ^{[21
]}

Garges, H. ^{[22
]}

Rogatto, F. ^{[23
]}

Neesgaard, B. ^{[24
]}

Peters, L. ^{[24
]}

Lundgren, J. D. ^{[24
]}

Ryom, L. ^{[24
]}

机构：

[1] UCL, Ctr Clin Res Modelling & Evaluat CREME, Inst Global Hlth, London, England

[2] Kirby Inst, Kensington, NSW, Australia

[3] Stichting HIV Monitoring SHM, Amsterdam, Netherlands

[4] Univ Hosp Cologne, Cologne, Germany

[5] Azienda Policlin Univ Modena, Modena, Italy

[6] Univ Barcelona, Infect Dis Serv, Hosp Clin IDIBAPS, Barcelona, Spain

[7] Kepler Univ Klinikum Med Campus III, Linz, Austria

[8] Paracelsus Med Univ, Dept Internal Med Haematol Med Oncol Haemostaseol, Oncol Ctr, Salzburg, Austria

[9] Univ Zurich, Zurich, Switzerland

[10] Univ Hosp Zurich, Zurich, Switzerland

[11] Univ Hosp Basel, Basel Inst Clin Epidemiol & Biostat, Dept Clin Res, Basel, Switzerland

[12] Univ Basel, Basel, Switzerland

[13] Ctr Rech Malad Infect Asb1, Brussels, Belgium

[14] Univ Vita Salute San Raffaele, Milan, Italy

[15] ASST Santi Paolo & Carlo, Italian Cohort Naive Antiretrovirals ICONA, Milan, Italy

[16] Georgian Natl AIDS Hlth Informat Syst AIDS HIS, Infect Dis AIDS & Clin Immunol Res Ctr, Tbilisi, Georgia

[17] Alfred Hosp, Dept Infect Dis, Melbourne, Vic, Australia

[18] Monash Univ, Melbourne, Vic, Australia

[19] Karolinska Univ Hosp, Stockholm, Sweden

[20] Chelsea & Westminster Hosp, London, England

[21] European AIDS Treatment Grp, London, England

[22] ViiV Healthcare, London, England

[23] Gilead Sci, Foster City, CA USA

[24] Univ Copenhagen, Rigshosp, Dept Infect Dis, CHIP, Sect 2100, Copenhagen, Denmark

来源：

AIDS | 2021年 / 35卷 / 05期

关键词：

cancer; immune suppression; smoking; viral replication; AIDS-DEFINING MALIGNANCIES; ANTIRETROVIRAL THERAPY; CIGARETTE-SMOKING; LUNG-CANCER; INFECTED INDIVIDUALS; TOBACCO SMOKING; HARM REDUCTION; RISK-FACTORS; NICOTINE; POPULATION;

D O I：

10.1097/QAD.0000000000002791

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background: It is unknown if the carcinogenic effect of smoking is influenced by CD4(+) cell count and viral load in persons living with HIV. Material and methods: RESPOND participants with known smoking status were included. Poisson regression adjusting for baseline confounders investigated the interaction between current CD4(+)/viral load strata [good (CD4(+) cell count >= 500 cells/mu l and viral load <200 copies/ml], poor [CD4(+) cell count <= 350 cells/mu l and viral load >200 copies/ml] and intermediate [all other combinations]), smoking status and all cancers, non-AIDS defining cancers (NADCs), smoking-related cancers (SRCs) and infection-related cancers (IRCs). Results: Out of 19 602 persons, 41.3% were never smokers, 44.4% current and 14.4% previous smokers at baseline. CD4(+)/viral load strata were poor in 3.4%, intermediate in 44.8% and good in 51.8%. There were 513 incident cancers; incidence rate 6.9/1000 person-years of follow-up (PYFU) [95% confidence interval (95% CI) 6.3-7.5]. Current smokers had higher incidence of all cancer (adjusted incidence rate ratio 1.45; 1.17-1.79), NADC (1.65; 1.31-2.09), SRC (2.21; 1.53-3.20) and IRC (1.38; 0.97-1.96) vs. never smokers. Those with poor CD4(+)/viral load had increased incidence of all cancer (5.36; 95% CI 3.71-7.75), NADC (3.14; 1.92-5.14), SRC (1.82; 0.76-4.41) and IRC (10.21; 6.06-17.20) vs. those with good CD4(+)/viral load. There was no evidence that the association between smoking and cancer subtypes differed depending on the CD4(+)/viral load strata (P > 0.1, test for interaction). Conclusion: In the large RESPOND consortium, the impact of smoking on cancer was clear and reducing smoking rates should remain a priority. The association between current immune deficiency, virological control and cancer was similar for never smokers, current smokers and previous smokers suggesting similar carcinogenic effects of smoking regardless of CD4(+) cell count and viral load.

引用

页码：747 / 757

页数：11

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