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大人のエイズ関連の免疫抑制とがんの関連性
M Frisch1, R J Biggar, E A Engels
1Danish Epidemiology Science Center, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen S, Denmark. mfr@ssi.dk
JAMA
|April 13, 2001
まとめ
ヒト免疫不全ウイルス (HIV) と獲得免疫不全症候群 (AIDS) の患者のがんを研究した. いくつかの非エイズを定義する癌は過剰なリスクを示したが,ホジキン病のような特定のタイプのみが免疫抑制と関連している可能性がある.
科学分野:
- エピデミオロジー エピデミオロジー
- 免疫学 免疫学とは
- 腫瘍学 腫瘍学
背景:
- カポシ・サルコマ,ノン・ホッジキンリンパ腫,子宮頸がん以外のがんを特定するために大規模な研究が必要であり,HIV/エイズ患者ではより高い割合で発生することがあります.
- HIV/AIDS患者の癌のパターンを理解することは,公衆衛生イニシアチブと臨床管理にとって極めて重要です.
研究 の 目的:
- HIV/AIDSと診断された成人の全般的ながん発生率を調査する.
- HIV/AIDS集団において,免疫抑制と直接関連しているがんと,他の潜在的な原因を持つがんを区別する.
主な方法:
- 1978年から1996年の間に,米国の11の異なる地域から302,834人の成人を対象とした,人口ベースのエイズとがんの登録データをリンクした分析.
- 様々ながんに対する相対リスク (RRs) の計算は,一般人口の割合に基づいて,観察された症例と予想される数を比較することによって行われます.
- 3つの基準を用いて免疫抑制関連がんの定義:全体的なRRの上昇,エイズ後のRRの上昇,そしてエイズ発症の頃にRRの増加傾向.
主要な成果:
- AIDSを定義する癌とAIDSを定義しない癌の両方に統計的に有意な過剰が観察されました (全体RR, 2.7).
- 3つの免疫抑制基準を満たす特定の癌には,ホッジキン病 (RR,11.5),肺がん (RR,4.5),ペニルがん (RR,3.9),軟組織悪性腫瘍 (RR,3.3),唇がん (RR,3.1),および丸半球腫 (RR,2.0) が含まれる.
- ホッジキン病のサブタイプ (混合細胞性およびリンパ球枯渇) は,特に高い相対リスクを示しました.
結論:
- HIV/AIDS患者の過剰発生率を有する非エイズを定義するほとんどの癌は,免疫抑制の進行によって直接引き起こされるようには見えません.
- 重度の喫煙 (肺がん),ヒトパピローマウイルス感染 (ペニルがん),または誤った分類 (軟組織悪性腫瘍) などの要因は,いくつかの過剰を説明する可能性があります.
- ホッジキン病 (特に混合細胞性およびリンパ球枯渇サブタイプ),および潜在的に唇癌および丸セミノーマは,HIV関連の免疫抑制との真の関連についてさらなる調査を正当化します.
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