title: Cumulative HIV viremia during highly active antiretroviral therapy is a strong predictor of AIDS-related lymphoma.
abstract: BACKGROUND
  AIDS-related lymphoma contributes to significant morbidity and mortality among human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART). We assessed the predictive role of cumulative HIV viremia and other risk factors in the development of AIDS-related non-Hodgkin lymphoma.
  
  
  METHODS
  Data from the Clinical Surveillance of HIV Disease (ClinSurv) study, an ongoing, observational, open cohort study of HIV-infected patients from different urban areas in Germany, were analyzed using a Cox proportional hazards model.
  
  
  RESULTS
  In the Cox model, which comprised 6022 patients and 27,812 patient-years of follow-up while patients were receiving HAART from 1999 through 2006, cumulative HIV viremia was found to be independently associated with the risk of lymphoma (hazard ratio, [HR], 1.67 [95% confidence interval {CI}, 1.27-2.20]) (P < .001]). This association differed markedly between lymphoma subtypes. Although the association was more pronounced for Burkitt-type lymphoma (HR, 3.45 [95% CI, 1.52-7.85]) (P = .003), there was no association between cumulative HIV viremia and the incidence of primary central nervous system lymphoma (HR, 1.00 [95% CI, 0.39-2.57]) (P = .997). Other risk factors associated with an increased risk in a multivariable analysis included the latest CD4 T cell count as well as age per 10-year increment.
  
  
  CONCLUSIONS
  Cumulative HIV viremia is an independent and strong predictor of AIDS-related lymphoma among patients receiving HAART. The influence of cumulative HIV viremia may differ between lymphoma subtypes.
authors.affiliation: Infectious Diseases Unit, Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany. a.zoufaly@uke.uni-hamburg.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Zoufaly
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Stellbrink
authors.forename: Matthias An der
authors.initials: MA
authors.lastname: Heiden
authors.forename: Christian
authors.initials: C
authors.lastname: Kollan
authors.forename: Christian
authors.initials: C
authors.lastname: Hoffmann
authors.forename: Jan
authors.initials: J
authors.lastname: van Lunzen
authors.forename: Osamah
authors.initials: O
authors.lastname: Hamouda
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D019562:Viral Load; D014766:Viremia / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology