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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Association of early HIV viremia with mortality after HIV-associated lymphoma
AIDS, Volume 27, No. 15, Year 2013
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Description
Objective: To examine the association between early HIV viremia and mortality after HIV-associated lymphoma. Design: Multicenter observational cohort study. Setting: Center for AIDS Research Network of Integrated Clinical Systems cohort. Participants: HIV-infected patients with lymphoma diagnosed between 1996 and 2011, who were alive 6 months after lymphoma diagnosis and with at least two HIV RNA values during the 6 months after lymphoma diagnosis. Exposure: Cumulative HIV viremia during the 6 months after lymphoma diagnosis, expressed as viremia copy-6-months. Main outcome measure: All-cause mortality between 6 months and 5 years after lymphoma diagnosis. Results: Of 224 included patients, 183 (82%) had non-Hodgkin lymphoma (NHL) and 41 (18%) had Hodgkin lymphoma. At lymphoma diagnosis, 105 (47%) patients were on antiretroviral therapy (ART), median CD4+ cell count was 148 cells/μl (interquartile range 54-322), and 33% had suppressed HIV RNA (<400 copies/ml). In adjusted analyses, mortality was associated with older age [adjusted hazard ratio (AHR) 1.37 per decade increase, 95% CI 1.03-1.83], lymphoma occurrence on ART (AHR 1.63, 95% CI 1.02-2.63), lower CD4+ cell count (AHR 0.75 per 100 cells/μl increase, 95% CI 0.64-0.89), and higher early cumulative viremia (AHR 1.35 per log10copies × 6-months/ml, 95% CI 1.11-1.65). The detrimental effect of early cumulative viremia was consistent across patient groups defined by ART status, CD4 + cell count, and histology. Conclusion: Exposure to each additional 1-unit log10 in HIV RNA throughout the 6 months after lymphoma diagnosis was associated with a 35% increase in subsequent mortality. These results suggest that early and effective ART during chemotherapy may improve survival. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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: 31
Authors: 14
Affiliations: 9
Identifiers
Doi:
10.1097/QAD.0b013e3283635232
ISSN:
14735571
Research Areas
Cancer
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative