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Factores de riesgo para la malignidad pediátrica relacionada con el virus de la inmunodeficiencia humana
Brad H Pollock1, Hal B Jenson, Charles T Leach
1Children's Cancer Research Institute, Center for Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, TX 78229-3900, USA. bpollock@uthscsa.edu
JAMA
|May 15, 2003
Resumen
La alta carga viral del virus de Epstein-Barr (EBV) está relacionada con un mayor riesgo de cáncer en niños con virus de la inmunodeficiencia humana (VIH), particularmente aquellos con mayores recuentos de células CD4. Otros factores como la ruta de infección y el uso de zidovudina no fueron factores de riesgo significativos.
Área de la Ciencia:
- Oncología Pediátrica Oncología Pediátrica.
- Enfermedades infecciosas Enfermedades infecciosas.
- Inmunología Inmunología.
Sus antecedentes:
- Los cánceres ocurren con mayor frecuencia en niños con infección por el virus de la inmunodeficiencia humana (VIH).
- Los factores de riesgo clínicos, inmunológicos y virales específicos para la malignidad en esta población siguen sin identificarse.
Objetivo del estudio:
- Para identificar los factores de riesgo para la malignidad entre los niños infectados con el VIH.
- Investigar la asociación entre el virus Epstein-Barr (EBV) y la malignidad en niños infectados por el VIH.
- Evaluar el papel del recuento de células CD4 y la terapia antirretroviral en las neoplasias pediátricas asociadas al VIH.
Principales métodos:
- Un estudio multicéntrico de casos y controles en el que participaron 43 niños infectados por el VIH con tumores malignos y 74 controles sin tumores malignos.
- Participantes emparejados basados en la duración de la infección por VIH, inscritos entre 1992 y 1998.
- Factores de riesgo evaluados que incluyen datos demográficos, características del VIH, tratamiento antirretroviral, recuento de células CD4 e infecciones covirales (EBV, citomegalovirus, herpesvirus humano 6) utilizando PCR y serología.
Principales resultados:
- La carga viral del virus Epstein-Barr (EBV) >50 copias/105 PBMCs se asoció fuertemente con el riesgo de cáncer en niños con recuentos de CD4 ≥200/μL (OR, 11.33; P<.001).
- Esta asociación no se observó en niños con recuentos de CD4 <200/μL (OR, 1.12; P=.99).
- La terapia con zidovudina y la ruta de infección por el VIH no fueron factores de protección o riesgo significativos.
Conclusiones:
- La alta carga viral EBV está asociada con el desarrollo de tumores malignos en niños infectados por el VIH, con el efecto modificado por el recuento de células CD4.
- Los datos demográficos, la ruta de infección y el uso de zidovudina no se relacionaron con el riesgo de cáncer maligno.
- La patogénesis de las neoplasias pediátricas relacionadas con el VIH requiere una mayor investigación para dilucidar otros factores contribuyentes.
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