Background/Objectives: Whilst cancer is a leading cause of death in people with HIV, less is known about clinical outcomes after cancer.Methods: Participants from the RESPOND and D:A:D cohorts with the five most common cancers (Kaposi’s sarcoma (KS); non-Hodgkin lymphoma (NHL); and lung, anal and prostate cancers) were followed from first cancer diagnosis after 2006/2012 [D:A:D/RESPOND] until death, final follow-up or administrative censoring (2016/2021). Incidence rates (IR) were calculated for post-cancer mortality; for non-fatal events (cardiovascular disease, diabetes, another primary cancer, AIDS events) individually and as a non-fatal composite clinical outcome (CCO). Predictors or mortality and CCO were assessed using Poisson regression with generalized estimating equations.Results: Amongst 2485 participants with cancer, mortality and CCO IRs were highest after lung cancer (445.4/1000 person years [95% CI 399.7, 494.9], 117.1 [94.3, 143.8], respectively) compared to other cancers and lowest after KS (21.3 [16.9, 26.6], 43.9 [37.5, 51.3]). The most common non-fatal outcomes were AIDS events after NHL and KS, diabetes after lung and prostate cancer and another primary cancer after anal cancer. Among people with NHL and anal cancer, a diagnosis in more recent years was associated with lower mortality risk. Increasing the time-updated CD4 count reduced mortality by 15–40% (per 100 cells/µL) after NHL and anal and lung cancers and reduced CCO risk by 17–28% after KS and NHL. Smoking, low BMI and multimorbidity increased CCO risks by two to three times after KS and NHL.Conclusions: Risk of post-cancer mortality and non-fatal outcomes varies by cancer type and risk profile, suggesting the need for personalized post-cancer clinical monitoring.
背景/目的：尽管癌症是HIV感染者死亡的主要原因，但关于癌症确诊后的临床结局所知较少。方法：对来自RESPOND和D:A:D队列的五种最常见癌症（卡波西肉瘤[KS]、非霍奇金淋巴瘤[NHL]以及肺癌、肛门癌和前列腺癌）患者进行随访，时间从2006/2012年[D:A:D/RESPOND]后首次癌症诊断开始，直至死亡、最终随访或行政删失（2016/2021年）。计算癌症后死亡率的发生率；针对非致命事件（心血管疾病、糖尿病、其他原发性癌症、艾滋病事件）分别计算，并作为非致命复合临床结局（CCO）进行计算。使用广义估计方程的泊松回归评估死亡率和CCO的预测因素。结果：在2485名癌症参与者中，与其他癌症相比，肺癌后的死亡率和CCO发生率最高（分别为445.4/1000人年[95% CI 399.7, 494.9]和117.1 [94.3, 143.8]），而KS后的发生率最低（21.3 [16.9, 26.6]和43.9 [37.5, 51.3]）。最常见的非致命结局是NHL和KS后的艾滋病事件、肺癌和前列腺癌后的糖尿病以及肛门癌后的其他原发性癌症。在NHL和肛门癌患者中，近年来的诊断与较低的死亡风险相关。随时间更新的CD4计数每增加100个细胞/µL，NHL、肛门癌和肺癌后的死亡率降低15-40%，KS和NHL后的CCO风险降低17-28%。吸烟、低体重指数和多病共存使KS和NHL后的CCO风险增加两到三倍。结论：癌症后死亡率和非致命结局的风险因癌症类型和风险特征而异，表明需要个性化的癌症后临床监测。
肿瘤(癌症)患者之家