title: Treatment and prognosis of AIDS-related lymphoma in the era of highly active antiretroviral therapy: findings from the Swiss HIV Cohort Study.
abstract: OBJECTIVE
  To assess the characteristics of combination antiretroviral therapy (cART) administered concomitantly with chemotherapy and to establish prognostic determinants of patients with AIDS-related non-Hodgkin's lymphoma.
  
  
  METHODS
  The study included 91 patients with AIDS-related non-Hodgkin's lymphoma from the Swiss HIV Cohort Study enrolled between January 1997 and October 2003, excluding lymphomas of the brain. We extracted AIDS-related non-Hodgkin's lymphoma- and HIV-specific variables at the time of lymphoma diagnosis as well as treatment changes over time from charts and from the Swiss HIV Cohort Study database. Cox regression analyses were performed to study predictors of overall and progression-free survival.
  
  
  RESULTS
  During a median follow up of 1.6 years, 57 patients died or progressed. Thirty-five patients stopped chemotherapy prematurely (before the sixth cycle) usually due to disease progression; these patients had a shorter median survival than those who completed six or more cycles (14 versus 28 months). Interruptions of cART decreased from 35% before chemotherapy to 5% during chemotherapy. Factors associated with overall survival were CD4+ T-cell count (<100 cells/microl) (hazard ratio [HR] 2.95 [95% confidence interval (CI) 1.53-5.67], hepatitis C seropositivity (HR 2.39 [95% CI 1.01-5.67]), the international prognostic index score (HR 1.98-3.62 across categories) and Burkitt histological subtypes (HR 2.56 [95% CI 1.13-5.78]).
  
  
  CONCLUSIONS
  Interruptions of cART were usually not induced by chemotherapy. The effect of cART interruptions on AIDS-related non-Hodgkin's lymphoma prognosis remains unclear, however, hepatitis C seropositivity emerged-as a predictor of death beyond the well-known international prognostic index score and CD4+ T-cell count.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland.
authors.forename: Mathew
authors.initials: M
authors.lastname: Simcock
authors.forename: Monika
authors.initials: M
authors.lastname: Blasko
authors.forename: Urs
authors.initials: U
authors.lastname: Karrer
authors.forename: Barbara
authors.initials: B
authors.lastname: Bertisch
authors.forename: Miklos
authors.initials: M
authors.lastname: Pless
authors.forename: Liisa
authors.initials: L
authors.lastname: Blumer
authors.forename: Samir
authors.initials: S
authors.lastname: Vora
authors.forename: James Owen
authors.initials: JO
authors.lastname: Robinson
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Benedetta
authors.initials: B
authors.lastname: Terziroli
authors.forename: Sophie
authors.initials: S
authors.lastname: Moirandat-Rytz
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.forename: Bernard
authors.initials: B
authors.lastname: Hirschel
authors.forename: Pietro
authors.initials: P
authors.lastname: Vernazza
authors.forename: Pedram
authors.initials: P
authors.lastname: Sendi
authors.forename: Martin
authors.initials: M
authors.lastname: Rickenbach
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Michael T
authors.initials: MT
authors.lastname: Koller
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D016483:Lymphoma, AIDS-Related / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents; D000970:Antineoplastic Agents