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. 2013 Aug 21;105(16):1221-9.
doi: 10.1093/jnci/djt158. Epub 2013 Jul 26.

Temporal trends in presentation and survival for HIV-associated lymphoma in the antiretroviral therapy era

Satish Gopal  1 , Monita R Patel, Elizabeth L Yanik, Stephen R Cole, Chad J Achenbach, Sonia Napravnik, Greer A Burkholder, Erin G Reid, Benigno Rodriguez, Steven G Deeks, Kenneth H Mayer, Richard D Moore, Mari M Kitahata, Joseph J Eron, Kristy L Richards
Affiliations

Temporal trends in presentation and survival for HIV-associated lymphoma in the antiretroviral therapy era

Satish Gopal et al. J Natl Cancer Inst. .

Abstract

Background: Lymphoma is the leading cause of cancer-related death among HIV-infected patients in the antiretroviral therapy (ART) era.

Methods: We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems from 1996 until 2010. We examined differences stratified by histology and diagnosis year. Mortality and predictors of death were analyzed using Kaplan-Meier curves and Cox proportional hazards.

Results: Of 23 050 HIV-infected individuals, 476 (2.1%) developed lymphoma (79 [16.6%] Hodgkin lymphoma [HL]; 201 [42.2%] diffuse large B-cell lymphoma [DLBCL]; 56 [11.8%] Burkitt lymphoma [BL]; 54 [11.3%] primary central nervous system lymphoma [PCNSL]; and 86 [18.1%] other non-Hodgkin lymphoma [NHL]). At diagnosis, HL patients had higher CD4 counts and lower HIV RNA than NHL patients. PCNSL patients had the lowest and BL patients had the highest CD4 counts among NHL categories. During the study period, CD4 count at lymphoma diagnosis progressively increased and HIV RNA decreased. Five-year survival was 61.6% for HL, 50.0% for BL, 44.1% for DLBCL, 43.3% for other NHL, and 22.8% for PCNSL. Mortality was associated with age (adjusted hazard ratio [AHR] = 1.28 per decade increase, 95% confidence interval [CI] = 1.06 to 1.54), lymphoma occurrence on ART (AHR = 2.21, 95% CI = 1.53 to 3.20), CD4 count (AHR = 0.81 per 100 cell/µL increase, 95% CI = 0.72 to 0.90), HIV RNA (AHR = 1.13 per log10copies/mL, 95% CI = 1.00 to 1.27), and histology but not earlier diagnosis year.

Conclusions: HIV-associated lymphoma is heterogeneous and changing, with less immunosuppression and greater HIV control at diagnosis. Stable survival and increased mortality for lymphoma occurring on ART call for greater biologic insights to improve outcomes.

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Figures

Figure 1.
Figure 1.
Proportional distribution of 476 HIV-associated lymphomas in the Center for AIDS Research Network of Integrated Clinical Systems cohort by lymphoma diagnosis year, 1996 to 2010. *Cochran–Armitage P trend for Burkitt lymphoma (BL) proportion relative to diffuse large B-cell lymphoma (DLBCL) is .01, BL relative to primary central nervous system lymphoma (PCNSL) is .02, and BL relative to all non-BL Non-Hodgkin lymphoma (NHL) is .02. For all other pairwise comparisons between lymphoma categories, Cochran–Armitage P trend is greater than .05. All reported statistical tests are two-sided. HL = Hodgkin lymphoma.
Figure 2.
Figure 2.
Cumulative mortality over time for Hodgkin lymphoma vs non-Hodgkin lymphoma (A) and non-Hodgkin lymphoma categories (B). *Number at risk may increase over time as a result of patients enrolled in Center for AIDS Research Network of Integrated Clinical Systems after lymphoma diagnosis who were treated as late entries. BL=Burkitt lymphoma; DLBCL = diffuse large B-cell lymphoma; HL = Hodgkin lymphoma; NHL = Non-Hodgkin lymphoma; PCNSL = primary central nervous system lymphoma.
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