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NHL incidence high in HIV despite treatment
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Researchers with the Centers for AIDS Research have found a high incidence of non-Hodgkin’s lymphoma among patients with HIV who are receiving antiretroviral therapy.
“[This high incidence] was noted even among patients with a nadir CD4 count of more than 200 cells/mcL, suggesting this cancer is associated with HIV infection above and beyond the level of immunodeficiency categorized as ‘AIDS-defining’ by the CDC in 1993,” the researchers wrote in Clinical Infectious Diseases. “Moving forward, studies should include NHL as an important clinical endpoint along with non-AIDS-defining cancers.”
The researchers evaluated the incidence of NHL among a cohort of patients with HIV who were enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). The CNICS cohort includes more than 27,000 patients with HIV from 1995 to present at eight sites in the country. This study included patients who started combination ART, achieved viral suppression and had at least 3 months of follow-up. Only patients from 1998 and later were included to assure sensitive viral load testing.
Among the 6,036 patients included in the study, there were 37 NHL diagnoses during 21,607 person-years of follow-up, for an incidence rate of 171 per 100,000 person-years. The HRs for NHL were higher among those with a current (HR=1.66; 95% CI, 0.7-3.94), 3-month lagged (HR=2.1; 95% CI, 0.84-5.22) and 6-month lagged (HR=1.46; 95% CI, 0.6-3.6) HIV viremia of 51 copies/mL to 500 copies/mL vs. those with an HIV viremia of 50 copies/mL or less. The HRs for NHL also were higher among those with a current (HR=2.39; 95% CI, 0.92-6.21), 3-month lagged (HR=3.56; 95% CI, 1.21-10.49) and 6-month lagged (HR=2.5; 95% CI, 0.91-6.84) HIV viremia of more than 500 copies/mL.
“Current HIV treatment guidelines in the United States recommend initiation of ART and maximum virologic suppression for nearly all infected patients, regardless of CD4 cell count, to reduce transmission, minimize AIDS and non-AIDS clinical events, and maximize life expectancy,” the researchers wrote. “Our study supports these recommendations and further contributes to mounting evidence that HIV replication, even at low levels, is associated with increased morbidity and mortality.”
Disclosure: The researchers report no relevant financial disclosures.
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