肺癌和艾滋病毒

Georgii Manikhas, Pavel Gavrilov
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摘要

在发达国家,非艾滋病定义的癌症已成为艾滋病后最常见的死亡原因,其中最常见的是肺癌。 本文的主要目的是研究艾滋病病毒感染情况下肺癌的病理特征、抗逆转录病毒疗法期间与艾滋病病毒相关的危险因素,并与这一问题的全球趋势进行比较。 研究人员回顾性分析了圣彼得堡数据库中 98 名肺癌和艾滋病病毒感染患者的医疗记录,这些患者于 2008 年至 2018 年期间接受了专业治疗。关于肺癌合并艾滋病病毒感染有几个重要问题。HIV感染肺癌患者比HIV阴性肺癌患者更年轻,病情更严重,更难治疗。HIV 阳性人群罹患肺癌的风险增加是多因素的。 人群中以青年(18-44 岁)和中年(45-59 岁)患者为主,分别占 45.9% 和 42.9%,老年患者(60-74 岁)占 11.2%,P0.001,符合全球 HIV 感染者肺癌发病率较高的数据。 与普通人群一样,腺癌是更常见的肺癌组织学亚型(P0.001)。 高病毒载量与肺癌之间没有静态意义,这表明不存在艾滋病病毒直接致癌的机制(中低病毒载量患者占 90.8%,P0.001)。然而,肺癌患者中艾滋病病毒感染 4 期(P0.001)的发生率表明,患者有包括肺部疾病在内的炎症性疾病史,这是 CD8+T 淋巴细胞功能障碍导致免疫抑制和微肿瘤环境形成的结果,这可能是这组患者发生肺癌的不利预后因素,也是病毒致癌的间接机制。 老年患者(11.2%,年龄在 MAX -71 岁之间)的出现间接表明俄罗斯这类患者的预期寿命在延长,从而使这一研究领域更具现实意义。
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Lung cancer and HIV
People, living with HIV, have a greater chance of malignancies especially with the success of antiretroviral therapy, and Non-AIDS-defining cancers have become the most common cause of death after AIDS and the most common of them is the lung cancer in developed countries. The main purpose of this article is to research nosological characteristics of lung cancer in the context of HIV infection, HIV-associated risk factors during ART and compare with global trends of this problem. Retrospectively were analyzed the medical documentation of 98 patients with lung cancer and HIV-infection, who were in database and received specialized treatment in St. Petersburg from 2008 to 2018 years. There are several important questions regarding to lung cancer with HIV-infection. HIV-infected lung cancer patients are younger than HIV-negative, have a more advanced disease and that is more difficult to treat. The increased risk of lung cancer in HIV-positive population is multifactorial. The population was dominated by patients of young (18-44 years old) and middle (45-59 years old) ages, 45.9% and 42.9%, respectively, and 11.2% of elderly patients (60-74 years old), p0.001, which satisfies the global data of earlier incidence of lung cancer in people living with HIV. Adenocarcinomas were more common histological subtype of lung cancer as in the general population (p0.001). There was no static significance between high viral load and lung cancer, which can indicate the absence of a direct mechanism of HIV-carcinogenesis (90.8% of patients with low and medium viral load, p0.001).Nevertheless, the prevalence of 4-stage of HIV infection among lung cancer patients (p0.001) indicates a history of inflammatory diseases, including pulmonary diseases, as a result of induced immunosuppression due to CD8+T-lymphocyte dysfunction and the formation of a micro-tumor environment, which can be a prognostic unfavorable factor in the occurrence of lung cancer in this group of patients , as well as indirect mechanism of viral carcinogenesis. The presence of elderly patients (11.2%, MAX -71 years) indirectly indicates an increasing of period of life expectancy among this category of patients in Russia, making this area of research more actual.
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