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Blood, 1 December 2006, Vol. 108, No. 12, pp. 3786-3791.
Prepublished online as a Blood First Edition Paper on August 17, 2006; DOI 10.1182/blood-2006-05-024109.
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IMMUNOBIOLOGY
Hodgkin lymphoma and immunodeficiency in persons with HIV/AIDS
Robert J. Biggar,
Elaine S. Jaffe,
James J. Goedert,
Anil Chaturvedi,
Ruth Pfeiffer,
Eric A. Engels, for the HIV/AIDS Cancer Match Study
From the Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, the Laboratory of Pathology, and the Biostatistics Branch, National Cancer Institute (NCI), National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD.
In persons with HIV/AIDS (PWHAs), Hodgkin lymphoma (HL) risk is increased. However, HL incidence in PWHAs has unexpectedly increased since highly active antiretroviral therapy (HAART) was introduced. We linked nationwide HIV/AIDS and cancer registry data from 1980 through 2002. Immunity was assessed by CD4 T-lymphocyte counts at AIDS onset. Annual HL incidence rates were calculated for 4 through 27 months after AIDS onset. During 477 368 person years (py's) of follow-up in 317 428 persons with AIDS (PWAs), 173 HL cases occurred (36.2 per 105 py's). Incidence was significantly higher in 1996 to 2002 than earlier. Incidence in PWAs with 150 to 199 CD4 cells/µL was 53.7 per 105 py's, whereas in PWAs with fewer than 50 CD4 cells/µL, it was 20.7 per 105 py's (Ptrend = .002). For each HL subtype, incidence decreased with declining CD4 counts, but nodular sclerosing decreased more precipitously than mixed cellularity, thereby increasing the proportion of mixed cellularity HL seen in PWAs. We conclude that HL incidence is lower with severe immunosuppression than with moderate immunosuppression, and HAART-related improvements in CD4 counts likely explain the increasing HL incidence in PWHAS observed since 1996. With more severe immunosuppression, nodular sclerosing HL becomes infrequent, explaining the higher proportion of mixed cellularity HL found in PWAs. Pathogenesis implications are discussed.
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