title: Prognosis of HIV-associated non-Hodgkin lymphoma in patients starting combination antiretroviral therapy.
abstract: OBJECTIVE
  We examined survival and prognostic factors of patients who developed HIV-associated non-Hodgkin lymphoma (NHL) in the era of combination antiretroviral therapy (cART).
  
  
  METHODS
  Multicohort collaboration of 33 European cohorts.
  
  
  METHODS
  We included all cART-naive patients enrolled in cohorts participating in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who were aged 16 years or older, started cART at some point after 1 January 1998 and developed NHL after 1 January 1998. Patients had to have a CD4 cell count after 1 January 1998 and one at diagnosis of the NHL. Survival and prognostic factors were estimated using Weibull models, with random effects accounting for heterogeneity between cohorts.
  
  
  RESULTS
  Of 67 659 patients who were followed up during 304 940 person-years, 1176 patients were diagnosed with NHL. Eight hundred and forty-seven patients (72%) from 22 cohorts met inclusion criteria. Survival at 1 year was 66% [95% confidence interval (CI) 63-70%] for systemic NHL (n = 763) and 54% (95% CI: 43-65%) for primary brain lymphoma (n = 84). Risk factors for death included low nadir CD4 cell counts and a history of injection drug use. Patients developing NHL on cART had an increased risk of death compared with patients who were cART naive at diagnosis.
  
  
  CONCLUSIONS
  In the era of cART two-thirds of patients diagnosed with HIV-related systemic NHL survive for longer than 1 year after diagnosis. Survival is poorer in patients diagnosed with primary brain lymphoma. More advanced immunodeficiency is the dominant prognostic factor for mortality in patients with HIV-related NHL.
authors.forename: Julia
authors.initials: J
authors.lastname: Bohlius
authors.forename: Kurt
authors.initials: K
authors.lastname: Schmidlin
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: Margaret
authors.initials: M
authors.lastname: May
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Caro Murillo
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.forename: Gary
authors.initials: G
authors.lastname: Clifford
authors.forename: Giota
authors.initials: G
authors.lastname: Touloumi
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Genevieve
authors.initials: G
authors.lastname: Chene
authors.forename: Jens
authors.initials: J
authors.lastname: Lundgren
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D015497:HIV-1; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult