title: Association of early HIV viremia with mortality after HIV-associated lymphoma.
abstract: OBJECTIVE
  To examine the association between early HIV viremia and mortality after HIV-associated lymphoma.
  
  
  METHODS
  Multicenter observational cohort study.
  
  
  METHODS
  Center for AIDS Research Network of Integrated Clinical Systems cohort.
  
  
  METHODS
  HIV-infected patients with lymphoma diagnosed between 1996 and 2011, who were alive 6 months after lymphoma diagnosis and with at least two HIV RNA values during the 6 months after lymphoma diagnosis.
  
  
  METHODS
  Cumulative HIV viremia during the 6 months after lymphoma diagnosis, expressed as viremia copy-6-months.
  
  
  METHODS
  All-cause mortality between 6 months and 5 years after lymphoma diagnosis.
  
  
  RESULTS
  Of 224 included patients, 183 (82%) had non-Hodgkin lymphoma (NHL) and 41 (18%) had Hodgkin lymphoma. At lymphoma diagnosis, 105 (47%) patients were on antiretroviral therapy (ART), median CD4⁺ cell count was 148 cells/μl (interquartile range 54-322), and 33% had suppressed HIV RNA (<400 copies/ml). In adjusted analyses, mortality was associated with older age [adjusted hazard ratio (AHR) 1.37 per decade increase, 95% CI 1.03-1.83], lymphoma occurrence on ART (AHR 1.63, 95% CI 1.02-2.63), lower CD4⁺ cell count (AHR 0.75 per 100 cells/μl increase, 95% CI 0.64-0.89), and higher early cumulative viremia (AHR 1.35 per log₁₀ copies × 6-months/ml, 95% CI 1.11-1.65). The detrimental effect of early cumulative viremia was consistent across patient groups defined by ART status, CD4⁺ cell count, and histology.
  
  
  CONCLUSIONS
  Exposure to each additional 1-unit log₁₀ in HIV RNA throughout the 6 months after lymphoma diagnosis was associated with a 35% increase in subsequent mortality. These results suggest that early and effective ART during chemotherapy may improve survival.
authors.affiliation: aUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina bNorthwestern University, Chicago, Illinois cUniversity of Alabama at Birmingham, Birmingham, Alabama dUniversity of California at San Diego, San Diego, California eCase Western Reserve University, Cleveland, Ohio fUniversity of California at San Francisco, San Francisco, California gFenway Health, Boston, Massachusetts hJohns Hopkins University, Baltimore, Maryland iUniversity of Washington, Seattle, Washington, USA. *Satish Gopal and Monita R. Patel contributed equally to the writing of the study.
authors.forename: Satish
authors.initials: S
authors.lastname: Gopal
authors.forename: Monita R
authors.initials: MR
authors.lastname: Patel
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Yanik
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Achenbach
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Greer A
authors.initials: GA
authors.lastname: Burkholder
authors.forename: Erin G
authors.initials: EG
authors.lastname: Reid
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodriguez
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Richards
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy / Q000401:mortality*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood*; D012307:Risk Factors; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy / Q000401:mortality*
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral