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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Temporal trends in presentation and survival for HIV-associated lymphoma in the antiretroviral therapy era
Journal of the National Cancer Institute, Volume 105, No. 16, Year 2013
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Description
Background Lymphoma is the leading cause of cancer-related death among HIV-infected patients in the antiretroviral therapy (ART) era. Methods We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems from 1996 until 2010. We examined differences stratified by histology and diagnosis year. Mortality and predictors of death were analyzed using Kaplan-Meier curves and Cox proportional hazards. Results Of 23 050 HIV-infected individuals, 476 (2.1%) developed lymphoma (79 [16.6%] Hodgkin lymphoma [HL]; 201 [42.2%] diffuse large B-cell lymphoma [DLBCL]; 56 [11.8%] Burkitt lymphoma [BL]; 54 [11.3%] primary central nervous system lymphoma [PCNSL]; and 86 [18.1%] other non-Hodgkin lymphoma [NHL]). At diagnosis, HL patients had higher CD4 counts and lower HIV RNA than NHL patients. PCNSL patients had the lowest and BL patients had the highest CD4 counts among NHL categories. During the study period, CD4 count at lymphoma diagnosis progressively increased and HIV RNA decreased. Five-year survival was 61.6% for HL, 50.0% for BL, 44.1% for DLBCL, 43.3% for other NHL, and 22.8% for PCNSL. Mortality was associated with age (adjusted hazard ratio [AHR] = 1.28 per decade increase, 95% confidence interval [CI] = 1.06 to 1.54), lymphoma occurrence on ART (AHR = 2.21, 95% CI = 1.53 to 3.20), CD4 count (AHR = 0.81 per 100 cell/μL increase, 95% CI = 0.72 to 0.90), HIV RNA (AHR = 1.13 per log 10copies/mL, 95% CI = 1.00 to 1.27), and histology but not earlier diagnosis year. Conclusions HIV-associated lymphoma is heterogeneous and changing, with less immunosuppression and greater HIV control at diagnosis. Stable survival and increased mortality for lymphoma occurring on ART call for greater biologic insights to improve outcomes. © The Author 2013.
Authors & Co-Authors
Gopal, Satish
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Patel, Monita R.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Yanik, Elizabeth L.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Cole, Stephen R.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Achenbach, Chad J.
United States, Evanston
Northwestern University
Napravnik, Sonia
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Burkholder, Greer A.
United States, Birmingham
The University of Alabama at Birmingham
Reid, Erin Gourley
United States, La Jolla
University of California, San Diego
Rodriguez, Benigno A.
United States, Cleveland
Case Western Reserve University
Deeks, Steven G.
United States, San Francisco
University of California, San Francisco
Mayer, Kenneth H.
United States, Boston
Fenway Community Health Center
Moore, Richard D.
United States, Baltimore
Johns Hopkins University
Kitahata, Mari M.
United States, Seattle
University of Washington
Eron, Joseph J.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 132
Authors: 14
Affiliations: 9
Identifiers
Doi:
10.1093/jnci/djt158
ISSN:
14602105
Research Areas
Cancer
Environmental
Infectious Diseases