Prognosis of HIV-associated non-Hodgkin lymphoma in patients starting combination antiretroviral therapy

TY - JOUR

T1 - Prognosis of HIV-associated non-Hodgkin lymphoma in patients starting combination antiretroviral therapy

AU - Bohlius, Julia

AU - Schmidlin, Kurt

AU - Costagliola, Dominique

AU - Fätkenheuer, Gerd

AU - May, Margaret

AU - Caro Murillo, Ana Maria

AU - Mocroft, Amanda

AU - Bonnet, Fabrice

AU - Clifford, Gary

AU - Touloumi, Giota

AU - Miro, Jose M

AU - Chene, Genevieve

AU - Lundgren, Jens

AU - Egger, Matthias

AU - Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study group

N1 - Keywords: Adolescent; Adult; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Epidemiologic Methods; Europe; Female; HIV-1; Humans; Lymphoma, AIDS-Related; Lymphoma, Non-Hodgkin; Male; Middle Aged; Prognosis; Treatment Outcome; Young Adult

PY - 2009

Y1 - 2009

N2 - OBJECTIVE: We examined survival and prognostic factors of patients who developed HIV-associated non-Hodgkin lymphoma (NHL) in the era of combination antiretroviral therapy (cART). DESIGN AND SETTING: Multicohort collaboration of 33 European cohorts. METHODS: We included all cART-naive patients enrolled in cohorts participating in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who were aged 16 years or older, started cART at some point after 1 January 1998 and developed NHL after 1 January 1998. Patients had to have a CD4 cell count after 1 January 1998 and one at diagnosis of the NHL. Survival and prognostic factors were estimated using Weibull models, with random effects accounting for heterogeneity between cohorts. RESULTS: Of 67 659 patients who were followed up during 304 940 person-years, 1176 patients were diagnosed with NHL. Eight hundred and forty-seven patients (72%) from 22 cohorts met inclusion criteria. Survival at 1 year was 66% [95% confidence interval (CI) 63-70%] for systemic NHL (n = 763) and 54% (95% CI: 43-65%) for primary brain lymphoma (n = 84). Risk factors for death included low nadir CD4 cell counts and a history of injection drug use. Patients developing NHL on cART had an increased risk of death compared with patients who were cART naive at diagnosis. CONCLUSION: In the era of cART two-thirds of patients diagnosed with HIV-related systemic NHL survive for longer than 1 year after diagnosis. Survival is poorer in patients diagnosed with primary brain lymphoma. More advanced immunodeficiency is the dominant prognostic factor for mortality in patients with HIV-related NHL.

AB - OBJECTIVE: We examined survival and prognostic factors of patients who developed HIV-associated non-Hodgkin lymphoma (NHL) in the era of combination antiretroviral therapy (cART). DESIGN AND SETTING: Multicohort collaboration of 33 European cohorts. METHODS: We included all cART-naive patients enrolled in cohorts participating in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who were aged 16 years or older, started cART at some point after 1 January 1998 and developed NHL after 1 January 1998. Patients had to have a CD4 cell count after 1 January 1998 and one at diagnosis of the NHL. Survival and prognostic factors were estimated using Weibull models, with random effects accounting for heterogeneity between cohorts. RESULTS: Of 67 659 patients who were followed up during 304 940 person-years, 1176 patients were diagnosed with NHL. Eight hundred and forty-seven patients (72%) from 22 cohorts met inclusion criteria. Survival at 1 year was 66% [95% confidence interval (CI) 63-70%] for systemic NHL (n = 763) and 54% (95% CI: 43-65%) for primary brain lymphoma (n = 84). Risk factors for death included low nadir CD4 cell counts and a history of injection drug use. Patients developing NHL on cART had an increased risk of death compared with patients who were cART naive at diagnosis. CONCLUSION: In the era of cART two-thirds of patients diagnosed with HIV-related systemic NHL survive for longer than 1 year after diagnosis. Survival is poorer in patients diagnosed with primary brain lymphoma. More advanced immunodeficiency is the dominant prognostic factor for mortality in patients with HIV-related NHL.

U2 - 10.1097/QAD.0b013e32832e531c

DO - 10.1097/QAD.0b013e32832e531c

M3 - Journal article

C2 - 19531926

SN - 1350-2840

VL - 23

SP - 2029

EP - 2037

JO - AIDS, Supplement

JF - AIDS, Supplement

IS - 15

ER -