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

Satish Gopal*, 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

96 Scopus citations

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 log 10copies/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.

Original languageEnglish (US)
Pages (from-to)1221-1229
Number of pages9
JournalJournal of the National Cancer Institute
Volume105
Issue number16
DOIs
StatePublished - Aug 21 2013

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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