Incidence and risk factors of HIV-related non-Hodgkin's lymphoma in the era of combination antiretroviral therapy: a European multicohort study
Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Study Group, Julia Bohlius, Kurt Schmidlin, Dominique Costagliola, Gerd Fätkenheuer, Margaret May, Anna Maria Caro-Murillo, Amanda Mocroft, Fabrice Bonnet, Gary Clifford, Anastasia Karafoulidou, Jose M Miro, Jens Lundgren, Genevieve Chene, Matthias Egger, Andrea Antinori, Fabrice Bonnet, François Boué, Norbert Brockmeyer, Jordi Casabona, Dominique Costagliola, Fernando Dronda, Niels Obel, Gerd Fätkenheuer, Martin Fisher, Silvia Franceschi, Diana Gibb, Vincent Le Moing, Amanda Mocroft, David Nadal, Giota Touloumi, Maria Prins, François Raffi, Bernardino Roca, Annelies Verbon, Timo Wolf, Claudia Fortuny, Julia Bohlius, Rana Chakraborty, Gary Clifford, Matthias Egger, Silvia Franceschi, Margaret May, Christoph Minder, Jonathan Sterne, Marcel Zwahlen, Michelle Ellefson, Jesper Kjaer, Fidéline Collin, Céline Colin, Ian Weller, Dominique Costagliola, Bruno Ledergerber, Jens Lundgren, Genevieve Chene, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Cecile Goujard, Catherine Leport, Frank de Wolf, Peter Reiss, Kholoud Porter, Maria Dorrucci, Caroline Sabin, Diana Gibb, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Schlomo Staszewski, Santiago Perez-Hoyos, Jesus Almeda, Andrea Antinori, Antonella d'Arminio Monforte, Maurizio de Martino, Norbert Brockmeyer, Gerd Fätkenheuer, Jose Ramos, Manuel Battegay, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M Miro, Antonella Castagna, Stephane de Wit, Carlo Torti, Ramon Teira, Myriam Garrido, Nikos Dedes, Caroline Sabin, Andrew Phillips, Hansjakob Furrer, Ole Kirk, Matthias Egger, François Dabis, Marie- Louise Newell, Jonathan Sterne, Amalio Telenti, Nikos Pantazis, Jérôme Lechenadec, Faroudy Jérôme, Laurent Tran, Eric Balestre, Emilie Lanoy, Françoise Couturier, Theo Rispens, Luuk A J Gras, Krishnan Bhaskaran, Caroline Sabin, Teresa Hill, Ali Judd, Trinh Duong, Paz Sobrino, Niels Obel, Claire Thorne, Jesper Kjaer, Beverley Jennings, Santiago Pérez-Hoyos, Jesus Almeda, Sandro Bonfigli, Alessandro Cozzi-Lepri, Stefano Corvasce, Fulvio Adorni, Anna Lisa Ridolfo, Giuseppe Paraninfo, Jose T Ramos, Olivia Keiser, Vanni Borghi, Janet Masters, Berta Ortiga, Stefania Salpietro, Martin Rickenbach, Benedicte Poll, Myriam Garrido, Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Study Group, Julia Bohlius, Kurt Schmidlin, Dominique Costagliola, Gerd Fätkenheuer, Margaret May, Anna Maria Caro-Murillo, Amanda Mocroft, Fabrice Bonnet, Gary Clifford, Anastasia Karafoulidou, Jose M Miro, Jens Lundgren, Genevieve Chene, Matthias Egger, Andrea Antinori, Fabrice Bonnet, François Boué, Norbert Brockmeyer, Jordi Casabona, Dominique Costagliola, Fernando Dronda, Niels Obel, Gerd Fätkenheuer, Martin Fisher, Silvia Franceschi, Diana Gibb, Vincent Le Moing, Amanda Mocroft, David Nadal, Giota Touloumi, Maria Prins, François Raffi, Bernardino Roca, Annelies Verbon, Timo Wolf, Claudia Fortuny, Julia Bohlius, Rana Chakraborty, Gary Clifford, Matthias Egger, Silvia Franceschi, Margaret May, Christoph Minder, Jonathan Sterne, Marcel Zwahlen, Michelle Ellefson, Jesper Kjaer, Fidéline Collin, Céline Colin, Ian Weller, Dominique Costagliola, Bruno Ledergerber, Jens Lundgren, Genevieve Chene, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Cecile Goujard, Catherine Leport, Frank de Wolf, Peter Reiss, Kholoud Porter, Maria Dorrucci, Caroline Sabin, Diana Gibb, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Schlomo Staszewski, Santiago Perez-Hoyos, Jesus Almeda, Andrea Antinori, Antonella d'Arminio Monforte, Maurizio de Martino, Norbert Brockmeyer, Gerd Fätkenheuer, Jose Ramos, Manuel Battegay, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M Miro, Antonella Castagna, Stephane de Wit, Carlo Torti, Ramon Teira, Myriam Garrido, Nikos Dedes, Caroline Sabin, Andrew Phillips, Hansjakob Furrer, Ole Kirk, Matthias Egger, François Dabis, Marie- Louise Newell, Jonathan Sterne, Amalio Telenti, Nikos Pantazis, Jérôme Lechenadec, Faroudy Jérôme, Laurent Tran, Eric Balestre, Emilie Lanoy, Françoise Couturier, Theo Rispens, Luuk A J Gras, Krishnan Bhaskaran, Caroline Sabin, Teresa Hill, Ali Judd, Trinh Duong, Paz Sobrino, Niels Obel, Claire Thorne, Jesper Kjaer, Beverley Jennings, Santiago Pérez-Hoyos, Jesus Almeda, Sandro Bonfigli, Alessandro Cozzi-Lepri, Stefano Corvasce, Fulvio Adorni, Anna Lisa Ridolfo, Giuseppe Paraninfo, Jose T Ramos, Olivia Keiser, Vanni Borghi, Janet Masters, Berta Ortiga, Stefania Salpietro, Martin Rickenbach, Benedicte Poll, Myriam Garrido
Abstract
Background: Incidence and risk factors of HIV-associated non-Hodgkin's lymphoma (NHL) are not well defined in the era of combination antiretroviral therapy (cART).
Methods: A total of 56,305 adult HIV type-1 (HIV-1)-infected patients who started cART in 1 of 22 prospective studies in Europe were included. Weibull random effects models were used to estimate hazard ratios (HRs) for developing systemic NHL and included CD4(+) T-cell counts and viral load as time-updated variables.
Results: During the 212,042 person-years of follow-up, 521 patients were diagnosed with systemic NHL and 62 with primary brain lymphoma (PBL). The incidence rate of systemic NHL was 463 per 100,000 person-years not on cART and 205 per 100,000 person-years in treated patients for a rate ratio of 0.44 (95% confidence interval [CI] 0.37-0.53). The corresponding incidence rates of PBL were 57 and 24 per 100,000 person-years (rate ratio 0.43, 95% CI 0.25-0.73). Suppression of HIV-1 replication on cART (HR 0.60, 95% CI 0.44-0.81, comparing < or =500 with 10,000-99,999 copies/ml) and increases in CD4(+) T-cell counts (HR 0.30, 0.22-0.42, comparing > or =350 with 100-199 cells/microl) were protective; a history of Kaposi's sarcoma (HR 1.70, 1.08-2.68, compared to no history of AIDS), transmission through sex between men (HR 1.57, 1.19-2.08, compared with heterosexual transmission) and older age (HR 3.71, 2.37-5.80, comparing > or =50 with 16-29 years) were risk factors for systemic NHL.
Conclusions: The incidence rates of both systemic NHL and PBL were substantially reduced in patients on cART. Timely initiation of therapy is key to the prevention of NHL in the era of cART.
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Source: PubMed