title: Lymphoma immune reconstitution inflammatory syndrome in the center for AIDS research network of integrated clinical systems cohort.
abstract: BACKGROUND
  Lymphoma incidence is increased among human immunodeficiency virus (HIV)-infected individuals soon after antiretroviral therapy (ART), perhaps due to unmasking immune reconstitution inflammatory syndrome (IRIS). Clinical characteristics and survival for unmasking lymphoma IRIS have not been described.
  
  
  METHODS
  We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) from 1996 until 2011. Unmasking lymphoma IRIS was defined as lymphoma within 6 months after ART accompanied by a ≥ 0.5 log10 copies/mL HIV RNA reduction. Differences in presentation and survival were examined between IRIS and non-IRIS cases.
  
  
  RESULTS
  Of 482 lymphoma patients, 56 (12%) met criteria for unmasking lymphoma IRIS. Of these, 12 (21%) had Hodgkin lymphoma, 22 (39%) diffuse large B-cell lymphoma, 5 (9%) Burkitt lymphoma, 10 (18%) primary central nervous system lymphoma, and 7 (13%) other non-Hodgkin lymphoma. Median CD4 cell count at lymphoma diagnosis among IRIS cases was 173 cells/µL (interquartile range, 73-302), and 48% had suppressed HIV RNA <400 copies/mL. IRIS cases were similar overall to non-IRIS cases in histologic distribution and clinical characteristics, excepting more frequent hepatitis B and C (30% vs 19%, P = .05), and lower HIV RNA at lymphoma diagnosis resulting from the IRIS case definition. Overall survival at 5 years was similar between IRIS (49%; 95% confidence interval [CI], 37%-64%) and non-IRIS (44%; 95% CI, 39%-50%), although increased early mortality was suggested among IRIS cases.
  
  
  CONCLUSIONS
  In a large HIV-associated lymphoma cohort, 12% of patients met a uniformly applied unmasking lymphoma IRIS case definition. Detailed studies of lymphoma IRIS might identify immunologic mechanisms of lymphoma control.
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Satish
authors.initials: S
authors.lastname: Gopal
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Monita R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Achenbach
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Yanik
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Greer A
authors.initials: GA
authors.lastname: Burkholder
authors.affiliation: University of California, San Diego.
authors.forename: W Christopher
authors.initials: WC
authors.lastname: Mathews
authors.affiliation: Case Western Reserve University, Cleveland, Ohio.
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodriguez
authors.affiliation: University of California, San Francisco.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.affiliation: Fenway Health, Boston, Massachusetts.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: University of Washington, Seattle.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Richards
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology* / Q000401:mortality; D015994:Incidence; D008223:Lymphoma / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult
keywords: HIV/AIDS; Hodgkin lymphoma; immune reconstitution inflammatory syndrome; lymphoma; non-Hodgkin lymphoma
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