HIV-related Hodgkin lymphoma in the era of combination antiretroviral therapy: incidence, outcome, and evolution of CD4+ T cell lymphocytes
© Egger and COHERE Lymphoma Working Group; licensee BioMed Central Ltd. 2010
Published: 11 October 2010
HIV-infected patients are at increased risk to develop Hodgkin lymphoma (HL). We examined the incidence and risk factors for HL, the evolution of CD4 cell counts before HL diagnosis and prognosis of patients with HIV-related HL and in the era of combined antiretroviral therapy (cART) in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE).
Patients and methods
40,168 adult HIV-1 infected patients who started cART in one of 16 prospective cohort studies in Europe were included. Incidence rates per 100,000 person-years, Kaplan-Meier estimates of cumulative incidence and survival, and adjusted hazard ratios from Weibull random-effects models, with 95% confidence intervals (CIs), were calculated. CD4 counts over time were compared between patients who were free of AIDS, on cART and developed HL (cases), and control patients. Cases and controls were matched 1:5 for cohort, age, sex, risk group, CD4 cell count at start of cART, and HIV-1 RNA at reference date, defined as HL diagnosis (cases), or at identical length of followup since start of cART (controls). We used multilevel linear regression to model changes in CD4 cell counts after start of cART and during the year before reference date and tested for differences between slopes in cases and controls. The analysis was repeated for patients with non-Hodgkin lymphoma (NHL).
HL incidence rates were similar in cART treated and untreated patients. CD4 cells declined before HL diagnosis in patients on cART, despite undetectable viral load. In contrast, in NHL patients CD4 cell counts did not sharply decrease in the year before NHL diagnosis. Patients on successful cART who experience a sudden decline of CD4 counts should be investigated for HL.
This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.
This article is published under license to BioMed Central Ltd.