title: Clinical and immunologic profile of AIDS-related lymphoma in the era of highly active antiretroviral therapy.
abstract: Despite the decrease in HIV-associated morbidity and mortality with the advent of highly active antiretroviral therapy (HAART), the incidence of AIDS-related lymphoma (ARL) has not decreased as significantly. Therefore, we compared epidemiologic, immunologic, and clinical characteristics of patients diagnosed with ARL in the pre-HAART and HAART eras. We used the Adult and Adolescent Spectrum of HIV-Related Diseases database of Public Health-Seattle and King County to determine incidences and trends among patients with ARL in Seattle/King County, WA. We noted a significant decrease in the incidence of HAART-era patients with ARL (36.6 vs. 8.4 per 1000 person-years). The percentage of women (2% vs. 14%), minorities (black patients 9% vs. 29%; Hispanic patients 6% vs. 21%; Native American patients 0 vs. 14%), and individuals originating from outside the United States (10% vs. 29%) increased significantly. There was also a significant increase in patients diagnosed with ARL at CD4+ counts > or = 200 cells/microL (3% vs. 21%) and a large decrease in median HIV-1 viral loads at ARL diagnosis (264,667 copies/mL vs. 35,500 copies/mL). Median survival time increased from 3 months to 13 months, and there was a significant decrease in comorbid opportunistic illnesses (83% vs. 36%). In conclusion, ARL incidence decreased significantly and patient profiles changed substantially in the Seattle/King County ASD project. HAART-era patients with ARL were more likely women, minorities, have improved immunologic status, and fewer comorbid opportunistic illnesses. This changing profile of patients with ARL parallels larger changes seen among the general AIDS population in the HAART era.
authors.affiliation: School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Lindsay R
authors.initials: LR
authors.lastname: Barclay
authors.forename: Susan E
authors.initials: SE
authors.lastname: Buskin
authors.forename: Erin M
authors.initials: EM
authors.lastname: Kahle
authors.forename: David M
authors.initials: DM
authors.lastname: Aboulafia
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D006801:Humans; D015994:Incidence; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents