Demographic, immunologic, virologic, and histologic shifts occurring, but mortality stable
WEDNESDAY, July 31 (HealthDay News) -- HIV-associated lymphoma is highly heterogeneous in the current treatment era, but mortality has remained steady, according to a study published online July 26 in the Journal of the National Cancer Institute.
Satish Gopal, M.D., from the University of North Carolina at Chapel Hill, and colleagues studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems from 1996 until 2010. Differences in morality and predictors of death were assessed by histology and diagnosis year.
The researchers found that 2.1 percent (476) of 23,050 HIV-infected individuals developed lymphoma (16.6 percent Hodgkin's lymphoma [HL]; 42.2 percent diffuse large B-cell lymphoma; 11.8 percent Burkitt lymphoma [BL]; 11.3 percent primary central nervous system lymphoma [PCNSL]; and 18.1 percent other non-Hodgkin's lymphoma [NHL]). HL patients had higher CD4 counts and lower HIV RNA than NHL patients at diagnosis. CD4 counts were lowest among PCNSL patients and highest among BL patients, among NHL categories. Over the study period there were progressive increases in CD4 count at lymphoma diagnosis and decreased HIV RNA. Age (adjusted hazard ratio [aHR], 1.28 per decade increase), lymphoma occurrence on antiretroviral therapy (aHR, 2.21), CD4 count (aHR, 0.81 per 100 cell/µL increase), HIV RNA (aHR, 1.13 per log10copies/mL), and histology were associated with mortality. Earlier diagnosis year was not associated with mortality.
"HIV-associated lymphoma is heterogeneous and changing, with less immunosuppression and greater HIV control at diagnosis," the authors write.
Abstract (http://jnci.oxfordjournals.org/content/early/2013/07/22/jnci.djt158.abstract )Full Text (subscription or payment may be required) (http://jnci.oxfordjournals.org/content/early/2013/07/22/jnci.djt158.full )Editorial (subscription or payment may be required) (http://jnci.oxfordjournals.org/content/early/2013/07/22/jnci.djt192.extract )