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Blood, 1 December 2001, Vol. 98, No. 12, pp. 3406-3412
NEOPLASIA
Non-Hodgkin lymphoma in HIV-infected patients in
the era of highly active antiretroviral therapy
Ole Kirk,
Court Pedersen,
Alessandro Cozzi-Lepri,
Francisco Antunes,
Veronica Miller,
Jose M. Gatell,
Christine Katlama,
Adriano Lazzarin,
Peter Skinhøj, and
Simon E. Barton for the EuroSIDA Study
Group
From the EuroSIDA Coordinating Centre, Department of
Infectious Diseases, Hvidovre Hospital, Copenhagen,
Denmark; Department of Infectious Diseases, Odense
University Hospital, Odense, Denmark; Royal Free Centre
for HIV Medicine and Department of Primary Care and Population
Sciences, Royal Free and University College Medical School, Royal
Free Campus, London, United Kingdom; Department of
Infectious Diseases, Hospital Santa Maria, Lisbon,
Portugal; Zentrum der Inneren Medizin, J. W. Goethe
University, Frankfurt, Germany; Servicio Infecciones,
Hospital Clinic i Provincial, Barcelona, Spain; Department
de Medicine Tropicale, Hopital de la
Pitié-Salpêtrière, Paris, France;
Department of Infectious Diseases, Ospedale San Raffaele, Milan,
Italy; Department of Infectious Diseases, Rigshospitalet,
Copenhagen, Denmark; and St. Stephen's Clinic, Chelsea
and Westminster Hospital, London, United Kingdom.
This study was designed to assess the influence of highly active
antiretroviral therapy (HAART) on non-Hodgkin lymphoma (NHL) among
patients infected with human immunodeficiency virus (HIV). Within
EuroSIDA, a multicenter observational cohort of more than 8500 patients
from across Europe, the incidences of NHL and subtypes (Burkitt,
immunoblastic, primary brain lymphoma [PBL], and other/unknown histology) were determined according to calendar time of follow-up, and
for those who initiated HAART ( 3 drugs) also time on HAART. Potential
predictive factors of NHL were evaluated in Cox proportional hazard
models. Over 26 764 person-years of prospective follow-up (PYF) from
May 1994 to December 2000, the incidence of NHL decreased from 1.99 (95% confidence interval, 1.51-2.47) before September 1995 to 0.30 (0.19-0.42) cases/100 (PYF) after March 1999 (P < .001).
The incidence of all subtypes of NHL decreased significantly and most
pronouncedly for PBL. Among patients who started HAART, the incidence
of NHL decreased from 0.88 (0.60-1.16) within the first 12 months after
starting HAART to 0.45 (0.31-0.60) cases/100 PYF after more than 24 months (P = .004). In an adjusted Cox model for patients
on HAART, the latest CD4 cell count and plasma viral load were both
significantly associated with diagnosis of NHL; the relative hazard was
1.39 (range, 1.14-1.69) per 50% lower CD4 cell count, and 1.51 (range,
1.21-1.88) per 1 log higher plasma viral load. In conclusion, the
incidence of NHL among HIV-infected patients has decreased
significantly after the introduction of HAART, and the decline was most
pronounced for PBL. After starting HAART, patients with insufficient
immunologic and virologic responses were at highest risk of NHL.

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Related Letter in Blood Online:
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Systemic non-Hodgkin lymphoma in HIV-infected patients in the era of highly active antiretroviral therapy
- Regis A. Vilchez, Jeffrey L. Jorgensen, and Michael H. Kroll
Blood 2002 99: 4250-4251.
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