title: Temporal trends in presentation and survival for HIV-associated lymphoma in the antiretroviral therapy era.
abstract: BACKGROUND
  Lymphoma is the leading cause of cancer-related death among HIV-infected patients in the antiretroviral therapy (ART) era.
  
  
  METHODS
  We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems from 1996 until 2010. We examined differences stratified by histology and diagnosis year. Mortality and predictors of death were analyzed using Kaplan-Meier curves and Cox proportional hazards.
  
  
  RESULTS
  Of 23 050 HIV-infected individuals, 476 (2.1%) developed lymphoma (79 [16.6%] Hodgkin lymphoma [HL]; 201 [42.2%] diffuse large B-cell lymphoma [DLBCL]; 56 [11.8%] Burkitt lymphoma [BL]; 54 [11.3%] primary central nervous system lymphoma [PCNSL]; and 86 [18.1%] other non-Hodgkin lymphoma [NHL]). At diagnosis, HL patients had higher CD4 counts and lower HIV RNA than NHL patients. PCNSL patients had the lowest and BL patients had the highest CD4 counts among NHL categories. During the study period, CD4 count at lymphoma diagnosis progressively increased and HIV RNA decreased. Five-year survival was 61.6% for HL, 50.0% for BL, 44.1% for DLBCL, 43.3% for other NHL, and 22.8% for PCNSL. Mortality was associated with age (adjusted hazard ratio [AHR] = 1.28 per decade increase, 95% confidence interval [CI] = 1.06 to 1.54), lymphoma occurrence on ART (AHR = 2.21, 95% CI = 1.53 to 3.20), CD4 count (AHR = 0.81 per 100 cell/µL increase, 95% CI = 0.72 to 0.90), HIV RNA (AHR = 1.13 per log10copies/mL, 95% CI = 1.00 to 1.27), and histology but not earlier diagnosis year.
  
  
  CONCLUSIONS
  HIV-associated lymphoma is heterogeneous and changing, with less immunosuppression and greater HIV control at diagnosis. Stable survival and increased mortality for lymphoma occurring on ART call for greater biologic insights to improve outcomes.
authors.affiliation: Departments of Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. gopal@med.unc.edu
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: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Richards
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006689:Hodgkin Disease / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis* / Q000401:mortality*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000401:mortality; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D014481:United States / Q000453:epidemiology
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