Clifford et al. Respond to “Biological and Clinical Insights From Epidemiologic Research Into HIV, HPV, and Anal Cancer”
Nichée dans une étude de cohorte suisse, cette étude analyse les facteurs de risque associés au cancer de l'anus chez les patients infectés par le VIH (59 cas et 295 témoins)
We agree with Engels and Madeleine (1) that we may yet see declines in anal cancer incidence among human immunodeficiency virus (HIV)–infected persons in high-income countries as combined antiretroviral therapy (cART) is used increasingly earlier. This belief is based on the findings that immunodeficiency appears to particularly influence anal cancer risk years before cancer diagnosis, and that a large proportion of the excess anal cancer risk attributable to immunodeficiency can be explained by only moderately decreased CD4+ cell-counts. The relationship between CD4+ cell counts and anal cancer risk in the Swiss HIV Cohort Study (Table 3 in our original article (2)) can provide a rough estimate of the fraction of anal cancer that is avoidable through different improvements in immunostatus. By applying the Bruzzi method (3), we estimate that avoiding having CD4+ cell counts …
http://aje.oxfordjournals.org/content/early/2013/07/29/aje.kwt151.short 2013