Characteristics of non-Hodgkin lymphoma arising in HIV-infected patients with suppressed HIV replication.
OBJECTIVE
Despite effective treatment of HIV infection, some patients still develop non-Hodgkin lymphoma (NHL). We analysed patients with HIV-associated NHL and undetectable plasma HIV-RNA, according to the duration of HIV suppression.


METHODS
Out of 388 patients included in a prospective cohort of HIV-associated NHL from 1996 to 2008, 128 (33%) had a plasma HIV-RNA below 500 copies/ml and were included in the study. Patients with long-term HIV suppression (>18 months) were compared with patients with recent HIV suppression (< or = 18 months).


RESULTS
All patients but three were treated with combination antiretroviral therapy, with a median duration of 2.2 years. The median duration of HIV suppression was 10.1 months. Most cases (65%) occurred within 18 months following HIV suppression. In the more than 18 months group, patients developed NHL at a higher CD4 cell count than patients with 18 months or less of HIV suppression (359 versus 270 cells/microl, P = 0.02). None of the NHL characteristics were different between the two groups. Outcome was similar in the two groups (complete remission, 64 versus 72.5%; P = 0.35 and 3-year survival, 46 versus 56%; P = 0.08). In addition, 52% of the tumours were Epstein-Barr virus or human herpesvirus 8 associated, without any difference in the proportion of virus-associated tumours according to the duration of HIV suppression.


CONCLUSIONS
In patients with undetectable HIV-RNA, NHL occurred mainly within the first 18 months following HIV suppression. In patients developing NHL after long-term HIV suppression, the level of CD4 cell count was higher, but the association with Epstein-Barr virus or human herpesvirus 8 and the prognosis were similar to that observed in patients with recent HIV suppression.
Gérard
Laurence
L
Service d'Immunopathologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France. laurence.gerard@sls.aphp.fr
Meignin
Véronique
V
Galicier
Lionel
L
Fieschi
Claire
C
Leturque
Nicolas
N
Piketty
Christophe
C
Fonquernie
Laurent
L
Agbalika
Felix
F
Oksenhendler
Eric
E
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000502:physiology; D004854:Herpesvirus 4, Human / Q000276:immunology*; D019288:Herpesvirus 8, Human / Q000276:immunology*; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000276:immunology* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral; D014779:Virus Replication
D012367:RNA, Viral