Systematic evaluations of cancer risk in people living with HIV or AIDS (PLHIV) and solid organ transplant recipients provide unique insights into the role of the immune system in cancer development. In this systematic review and meta-analysis, we expand previous analyses of cancer risk for these two immunocompromised populations. We considered studies published in English and listed on PubMed or Embase up to July 1, 2022. Studies were eligible for inclusion if they used population-based registries and compared cancer incidence in PLHIV or solid organ transplant recipients with the general population in the same geographical area. We extracted the number of observed site-specific cancers and expected cases and calculated meta-standardised incidence ratios for cancer within PLHIV and solid organ transplant recipients. In solid organ transplant recipients meta-standardised incidence ratios were compared by organ type. This project is registered on PROSPERO, CRD42022366679. 46 studies in PLHIV and 67 in solid organ transplant recipients were included in the analysis. Meta-standardised incidence ratios for cancers associated with human papillomavirus were increased in both populations; the highest meta-standardised incidence ratio in PLHIV was anal cancer (37·28 [95% CI 23·65–58·75], =97·4%), and in solid organ transplant recipients was cutaneous squamous cell carcinoma (45·87 [31·70–66·38], =99·0%). Meta-standardised incidence ratios were significantly increased for most non-HPV viral-infection-related cancers in both populations; the highest standard incidence ratios were for Kaposi sarcoma (PLHIV: 801·52 [95% CI 200·25–3208·13], =100·0%; solid organ transplant recipients: 47·31 [23·09–96·95], =87·7%) and non-Hodgkin lymphoma (32·53 [19·64–53·87], =99·8%; 10·24 [8·48–12·35], =94·9%). Eight types of cancer with no known viral cause showed an increased risk in solid organ transplant recipients only; no cancer type showed increased risk in PLHIV only. Cancer risk was increased for a range of infection-related cancers in both PLHIV and solid organ transplant recipients, but divergent results in these and other cancers have emerged. The cancer risk patterns probably reflect variances in the degree of impaired immunity, exposure to carcinogenic viruses, and perhaps exposure to carcinogenic immunosuppressive agents. US National Cancer Institute, National Institutes of Health.

中文翻译：

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HIV 感染者和实体器官移植接受者的癌症风险：系统评价和荟萃分析


对艾滋病毒或艾滋病 (PLHIV) 感染者和实体器官移植受者的癌症风险进行系统评估，为了解免疫系统在癌症发展中的作用提供了独特的见解。在这次系统回顾和荟萃分析中，我们扩展了之前对这两个免疫功能低下人群的癌症风险的分析。我们考虑了截至 2022 年 7 月 1 日以英文发表并在 PubMed 或 Embase 上列出的研究。如果研究使用基于人群的登记并将 PLHIV 或实体器官移植接受者的癌症发病率与同一地理区域的一般人群进行比较，则研究符合纳入资格。区域。我们提取了观察到的特定部位癌症和预期病例的数量，并计算了 PLHIV 和实体器官移植受者中癌症的元标准化发病率。在实体器官移植受者中，按器官类型比较元标准化发病率。该项目在PROSPERO上注册，CRD42022366679。分析中纳入了 46 项针对 PLHIV 的研究和 67 项针对实体器官移植受者的研究。两个人群中与人乳头瘤病毒相关的癌症的元标准化发病率均有所增加； PLHIV 中最高的元标准化发病率是肛门癌（37·28 [95% CI 23·65–58·75]，=97·4%），实体器官移植受者中最高的元标准化发病率是皮肤鳞状细胞癌（45· 87 [31·70–66·38], =99·0%)。 在这两个人群中，大多数非 HPV 病毒感染相关癌症的元标准化发病率显着增加；最高标准发病率是卡波西肉瘤（PLHIV：801·52 [95% CI 200·25–3208·13]，=100·0%；实体器官移植受者：47·31 [23·09–96·95] ], =87·7%) 和非霍奇金淋巴瘤 (32·53 [19·64–53·87], =99·8%; 10·24 [8·48–12·35], =94·9 %）。没有已知病毒原因的八种癌症仅在实体器官移植受者中显示出风险增加；没有一种癌症类型仅显示艾滋病毒感染者的风险增加。在艾滋病毒感染者和实体器官移植受者中，一系列与感染相关的癌症的癌症风险都会增加，但这些癌症和其他癌症的结果却有所不同。癌症风险模式可能反映了免疫力受损程度、接触致癌病毒以及可能接触致癌免疫抑制剂的差异。美国国家癌症研究所、国立卫生研究院。