Prognosis of HIV-associated non-Hodgkin lymphoma in patients starting combination antiretroviral therapy.
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.
Bohlius
Julia
J
Schmidlin
Kurt
K
Costagliola
Dominique
D
Fätkenheuer
Gerd
G
May
Margaret
M
Caro Murillo
Ana Maria
AM
Mocroft
Amanda
A
Bonnet
Fabrice
F
Clifford
Gary
G
Touloumi
Giota
G
Miro
Jose M
JM
Chene
Genevieve
G
Lundgren
Jens
J
Egger
Matthias
M
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