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Inicio Medicina Clínica (English Edition) A case-control study of non-AIDS-defining cancers in a prospective cohort of HIV...
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Vol. 150. Issue 8.
Pages 291-296 (April 2018)
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Vol. 150. Issue 8.
Pages 291-296 (April 2018)
Original article
A case-control study of non-AIDS-defining cancers in a prospective cohort of HIV-infected patients
Estudio caso-control de tumores no definitorios de sida en una cohorte prospectiva de pacientes infectados por el VIH
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Francisco Rodríguez Arrondoa,
Corresponding author
, Miguel Ángel von Wichmanna, Xabier Caminoa, Miguel Ángel Goenagaa, Maialen Ibargurena, Harkaitz Azcunea, María Jesús Bustinduya, Oscar Ferrerob, Josefa Muñozb, Sofía Ibarrab, Koldo Aguirrebengoac, Josune Goicoetxeac, Elena Bereciartuac, Miguel Montejoc, M. Asunción Garcíad, Eduardo Martínezd, Joseba Portue, Luis Metolaf, Rafael Silvariñog, Cristina Sarasquetah, Julio Arrizabalagah, Jose Antonio Iribarrena, (SEINORTE Group)
a Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
b Servicio de Enfermedades Infecciosas, Hospital Basurto, Bilbao, Vizcaya, Spain
c Servicio de Enfermedades Infecciosas, Hospital de Cruces, Bilbao, Vizcaya, Spain
d Servicio de Enfermedades Infecciosas, Hospital Galdakao, Galdakao, Vizcaya, Spain
e Servicio de Médicina Interna, Hospital Txagorritxu, Vitoria-Gasteiz, Álava, Spain
f Servicio de Enfermedades Infecciosas, Hospital San Pedro, Logroño, La Rioja, Spain
g Servicio de Médicina Interna, Hospital San Eloy, Baracaldo, Vizcaya, Spain
h Servicio de Enfermedades Infecciosas, Instituto BioDonostia, San Sebastián, Guipúzcoa, Spain
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Tables (6)
Table 1. Epidemiological characteristics.
Table 2. non-AIDS-defining cancers.
Table 3. Risk factors for developing any type of non-AIDS-defining cancer.
Table 4. Mortality risk factors in patients with non-AIDS-defining cancers.
Table 5. Risk factors for developing non-AIDS-defining cancers associated with infections.
Table 6. Risk factors for developing non-AIDS-defining cancers associated with smoking.
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Abstract
Introduction

We present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality.

Methods

All NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected.

Results

Two hundred and twenty-one NADCs were diagnosed in an initial cohort of 7067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1000 people-year. In addition to ageing and smoking, time on ART (OR 1.11; 95% CI 1.05–1.17) and PI use (OR 1.72; 95% CI 1.0–2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99–1.0; p=0.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08–3.92) were associated with higher mortality.

Conclusions

Predictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS.

Keywords:
HIV infection
Non-AIDS defining cancers
Non AIDS-defining illnesses
Hepatocellular carcinoma
Lung cancer
Anal cancer
Head and neck cancer
Skin cancer
Hodgkin's lymphoma
Antiretroviral therapy
Resumen
Introducción

Presentamos un estudio caso-control de tumores no definitorios de sida (TNDS) en una cohorte de pacientes infectados por el VIH en la que valoramos las tasas de incidencia, supervivencia y factores pronósticos de mortalidad.

Métodos

Se recogieron de forma prospectiva en 7 hospitales, los diagnósticos de TNDS realizados de 2007 a 2011, con seguimiento posterior hasta diciembre de 2013. Se seleccionaron de forma aleatoria un grupo control de 221 pacientes VIH sin diagnóstico de cáncer.

Resultados

Se diagnosticaron 221 TNDS en una cohorte inicial de 7.067 pacientes VIH. Los más frecuentes: hepatocarcinoma 20,5%, pulmón 18,7%, cabeza y cuello 11,9% y anal 10,5%. La tasa de incidencia de desarrollo de TNDS fue de 7,84/1.000 pacientes-año. Además de la edad y el tabaco, el tiempo en TAR (OR 1,11; IC 95% 1,05-1,17) y el uso de IP (OR 1,72; IC 95% 1,0-2,96) aumentaron el riesgo de desarrollar un TNDS. Durante el seguimiento fallecieron el 53,42%, con una mediana de supervivencia de 199,5 días. En el análisis de los factores pronósticos de mortalidad, los valores bajos de CD4 en el momento del diagnóstico del tumor (OR 0,99; IC 95% 0,99-1,0; p=0,033) y el diagnóstico previo de sida (OR 2,06; IC 95% 1,08-3,92) se asociaron con una mayor mortalidad.

Conclusiones

Los predictores de TNDS en nuestra cohorte fueron la edad, el consumo de tabaco, los linfocitos CD4 y el mayor tiempo en TAR. La mortalidad es alta, siendo factores de riesgo los CD4 bajos en el momento del diagnóstico del TNDS y el diagnóstico previo de sida.

Palabras clave:
Infección por VIH
Tumores no definitorios de sida
Enfermedades no definitorias de sida
Hepatocarcinoma
Cáncer de pulmón
Cáncer anal
Cáncer de cabeza y cuello
Cáncer de piel
Linfoma de Hodgkin
Tratamiento antirretroviral

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