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. 2010 May 1;54(1):78-84.
doi: 10.1097/01.qai.0000371677.48743.8d.

Immunologic and virologic predictors of AIDS-related non-hodgkin lymphoma in the highly active antiretroviral therapy era

Eric A Engels  1 , Ruth M Pfeiffer, Ola Landgren, Richard D Moore
Affiliations

Immunologic and virologic predictors of AIDS-related non-hodgkin lymphoma in the highly active antiretroviral therapy era

Eric A Engels et al. J Acquir Immune Defic Syndr. .

Abstract

HIV-infected persons treated with highly active antiretroviral therapy (HAART) continue to have elevated risk for non-Hodgkin lymphoma (NHL). We conducted a retrospective cohort study of NHL among patients at an urban HIV clinic (N = 3025). Proportional hazards models identified immunologic and virologic predictors of NHL. Sixty-five NHLs arose during 1989 to 2006. NHL incidence declined over time. Nonetheless, 51 NHLs (78%) occurred within the HAART era (1996-2006). NHL risk increased with declining CD4 count (P trend < 0.0001) and increasing HIV viral load (P trend = 0.005). In a multivariable model, NHL risk was independently associated with both current CD4 count (hazard ratios 7.7 and 3.8, respectively, for CD4 counts 0-99 and 100-249 vs. 250+ cells/mm(3); P trend < 0.0001) and prior time spent with a viral load above 5.00 log(10) copies/mL (hazard ratios of 3.4, 2.6, and 6.8, respectively, for 0.1-0.4, 0.5-1.4, and 1.5+ yr vs. 0 yr; P trend = 0.004). Although serum globulin levels were elevated compared with the general population, NHL risk was unrelated to this B-cell activation marker (P = 0.39). Among HIV-infected individuals in the HAART era, NHLs are linked to immunosuppression and extended periods of uncontrolled HIV viremia. The association with high-level viremia could reflect detrimental effects on immune function related to incompletely effective HAART or direct effects on B cells.

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Figures

Figure 1
Figure 1
Non-Hodgkin lymphoma incidence and HAART use in HIV-infected patients followed in the Johns Hopkins Hospital Moore Clinic. Non-Hodgkin lymphoma (NHL) incidence is indicated with the solid line and filled circles, using the left vertical axis. The proportion of follow-up time during which HIV-infected people received highly active antiretroviral therapy (HAART) is displayed with the solid line and filled diamonds, using the right vertical axis. Data are not shown for 1989 and 1990, when there were no NHL events but little follow-up time.
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