Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy.
HIV infection is associated with a high incidence of AIDS-related lymphomas (ARLs). Since the use of highly active antiretroviral therapy (HAART), the incidence of AIDS-defining illnesses has decreased, leading to a significant improvement in survival of HIV-infected patients. The consequences of HAART use on ARL are under debate. This study compared the incidence and the characteristics of ARL before and after the use of HAART in a large population of HIV-infected patients in the French Hospital Database on HIV (FHDH) and particularly in 3 centers including 145 patients with proven lymphoma. Within the FHDH, the incidence of systemic ARL has decreased between 1993-1994 and 1997-1998, from 86.0 per 10 000 to 42.9 per 10 000 person-years (P < 10(-30)). The incidence of primary brain lymphoma has also fallen dramatically between the periods, from 27.8 per 10 000 to 9.7 per 10 000 person-years (P < 10(-11)). The analysis of 145 cases of ARL in 3 hospitals showed that known HIV history was longer in the second period than in the first period among patients with systemic ARL (98 versus 75 months; P <.01). Patients had a higher number of CD4 cells at diagnosis during the second period (191 versus 63/microL, P = 10(-3)). Survival of patients with systemic ARL also increased between the periods (from 6 to 20 months; P =.004). Therefore, the profile of ARL has changed since the era of HAART, with a lower incidence of systemic and brain ARL. The prognosis of systemic ARL has improved.
Besson
C
C
Hôpital Necker, SC4-INSERM, CHU Pitié Salpêtrière, Hôpital Rothschild, Paris, France. caroline.besson@nck.ap-hop-paris.fr
Goubar
A
A
Gabarre
J
J
Rozenbaum
W
W
Pialoux
G
G
Châtelet
F P
FP
Katlama
C
C
Charlotte
F
F
Dupont
B
B
Brousse
N
N
Huerre
M
M
Mikol
J
J
Camparo
P
P
Mokhtari
K
K
Tulliez
M
M
Salmon-Céron
D
D
Boué
F
F
Costagliola
D
D
Raphaël
M
M
D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D019992:Databases as Topic; D005260:Female; D005602:France / Q000453:epidemiology; D006678:HIV / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous; D015996:Survival Rate; D013997:Time Factors; D019562:Viral Load