Association of early HIV viremia with mortality after HIV-associated lymphoma

Abstract

Objective: To examine the association between early HIV viremia and mortality after HIV-associated lymphoma.

Design: Multicenter observational cohort study.

Setting: Center for AIDS Research Network of Integrated Clinical Systems cohort.

Participants: HIV-infected patients with lymphoma diagnosed between 1996 and 2011, who were alive 6 months after lymphoma diagnosis and with at least two HIV RNA values during the 6 months after lymphoma diagnosis.

Exposure: Cumulative HIV viremia during the 6 months after lymphoma diagnosis, expressed as viremia copy-6-months.

Main outcome measure: All-cause mortality between 6 months and 5 years after lymphoma diagnosis.

Results: Of 224 included patients, 183 (82%) had non-Hodgkin lymphoma (NHL) and 41 (18%) had Hodgkin lymphoma. At lymphoma diagnosis, 105 (47%) patients were on antiretroviral therapy (ART), median CD4⁺ cell count was 148 cells/μl (interquartile range 54-322), and 33% had suppressed HIV RNA (<400 copies/ml). In adjusted analyses, mortality was associated with older age [adjusted hazard ratio (AHR) 1.37 per decade increase, 95% CI 1.03-1.83], lymphoma occurrence on ART (AHR 1.63, 95% CI 1.02-2.63), lower CD4⁺ cell count (AHR 0.75 per 100 cells/μl increase, 95% CI 0.64-0.89), and higher early cumulative viremia (AHR 1.35 per log₁₀ copies × 6-months/ml, 95% CI 1.11-1.65). The detrimental effect of early cumulative viremia was consistent across patient groups defined by ART status, CD4⁺ cell count, and histology.

Conclusion: Exposure to each additional 1-unit log₁₀ in HIV RNA throughout the 6 months after lymphoma diagnosis was associated with a 35% increase in subsequent mortality. These results suggest that early and effective ART during chemotherapy may improve survival.

Fig. 1

Median HIV RNA and interquartile range for 224 HIV-infected adults in CNICS during the 6 months after lymphoma diagnosis, stratified by antiretroviral therapy (ART) status at lymphoma diagnosis.

Fig. 2

Cumulative mortality after lymphoma diagnosis for 224 HIV-infected adults in CNICS, stratified by HIV viremia copy-6 months (log₁₀copies × 6-months/mL).

Fig. 3

Adjusted mortality hazard ratios for HIV viremia-copy-6 months among HIV-infected adults in CNICS with lymphoma between 1996 and 2011, stratified by patient characteristics at lymphoma diagnosis. ART, antiretroviral therapy; HL, Hodgkin lymphoma; NHL, non-Hodgkin lymphoma.