title: Assessment of immunovirological features in HIV related non-Hodgkin lymphoma patients and their impact on outcome.
abstract: BACKGROUND
  Despite the era of highly active antiretroviral therapy, non-Hodgkin lymphoma (NHL) remains one of the main causes of death in HIV-infected patients, with a wide variation on the outcome.
  
  
  OBJECTIVE
  We investigated immunological status and EBV, HHV8, HIV viral load in a group of HIV-infected patients at diagnosis of NHL to evaluate their prognostic significance.
  
  
  METHODS
  Eighty-one consecutive HIV+ NHL patients were studied. CD4 and CD8 cell counts, HHV8 DNA, EBV DNA, HIV RNA and HIV DNA were assessed at diagnosis and at 3 months after chemotherapy initiation. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of disease free survival (DFS) and overall survival (OS) were computed according to CD4 and CD8 cell counts, EBV DNA, HIV RNA and HIV DNA. HRs were, thereafter, computed also for continuous variation of CD4, CD8 cell counts and EBV DNA.
  
  
  RESULTS
  In the multivariate analysis, CD4<160 and CD8<590 cell/μl and EBV DNA≥300 c/ml were independently associated to DFS (HR=2.98; 95%CI: 1.26-7.03; HR=2.65, 95%CI: 1.13-6.19; HR=4.01; 95%CI: 1.81-8.91) and OS (HR=3.32; 95%CI: 1.41-7.83; HR=4.62, 95%CI: 1.91-11.19; HR=3.11, 95%CI: 1.42-6.80). HRs for DFS and OS decreased continuously with increasing CD4 and CD8 cell counts, while they increased continuously with increasing EBV DNA levels.
  
  
  CONCLUSIONS
  The association with survival of low CD4 and CD8 cell counts and detectable EBV viremia, measured at lymphoma's diagnosis, identified three independent prognostic biomarkers that might help in the management of NHL HIV+ patients, offering complementary information in the ascertainment of their outcome.
authors.affiliation: Microbiology-Immunology and Virology Unit, Centro di Riferimento Oncologico, IRCCS, via F. Gallini 2, 33081 Aviano, Italy. rtedeschi@cro.it
authors.forename: Rosamaria
authors.initials: R
authors.lastname: Tedeschi
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Bortolin
authors.forename: Ettore
authors.initials: E
authors.lastname: Bidoli
authors.forename: Stefania
authors.initials: S
authors.lastname: Zanussi
authors.forename: Chiara
authors.initials: C
authors.lastname: Pratesi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Vaccher
authors.forename: Umberto
authors.initials: U
authors.lastname: Tirelli
authors.forename: Paolo
authors.initials: P
authors.lastname: De Paoli
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000502:physiology; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology / Q000502:physiology*; D019288:Herpesvirus 8, Human / Q000502:physiology; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000821:virology*; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000821:virology*; D055815:Young Adult