title: Longer duration of combination antiretroviral therapy reduces the risk of Hodgkin lymphoma: A cohort study of HIV-infected male veterans.
abstract: BACKGROUND
  Hodgkin lymphoma (HL) incidence has increased since combined antiretroviral therapy (cART) introduction. It is unclear how different cART classes (e.g., protease inhibitors (PI), non-nucleoside reverse transcription inhibitors (NNRTI)) influence HL. This study aimed to determine the effects of cART duration on HL incidence among HIV-infected veterans.
  
  
  METHODS
  We performed a retrospective cohort study utilizing the Veterans Affairs HIV Clinical Case Registry (1985-2010). HL cases were identified using ICD-9 codes (201.4-9). cART, PI, and NNRTI duration was the aggregate number of treatment days delivered. Incidence rates (IR) and rate ratios (IRR) were calculated from Poisson regression models to examine the effects of cART duration on HL.
  
  
  RESULTS
  31,576 cART users contributed 288,736 person-years (PY) and 211 HL cases (IR=7.3/10,000 person-years). HL incidence decreased from 25.1/10,000 PY (95%CI=18.9-33.4) within the first year of cART to 0.6/10,000 PY (95%CI=0.3-1.6) after ≥ 10 years. In multivariable models, each additional year of cART was associated with decreased HL incidence (IRR=0.80; 95%CI=0.75-0.86); similar effects were observed in models assessing HL incidence by PI and NNRTI.
  
  
  CONCLUSIONS
  Our findings indicate long-term cART of any class is associated with decreased HL risk. High HL incidence directly following cART initiation supports a potential immune reconstitution mechanism in HIV-related HL. Further research is needed to evaluate the interaction between early cART, immune reconstitution, and HL.
authors.affiliation: Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. Electronic address: marc.kowalkowski@carolinashealthcare.org.
authors.forename: M A
authors.initials: MA
authors.lastname: Kowalkowski
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Mims
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Day
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA.
authors.forename: X L
authors.initials: XL
authors.lastname: Du
authors.affiliation: Department of Biostatistics, University of Texas School of Public Health, Houston, TX, USA.
authors.forename: W
authors.initials: W
authors.lastname: Chan
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: E Y
authors.initials: EY
authors.lastname: Chiao
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications*; D006689:Hodgkin Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014728:Veterans
chemical_list: D019380:Anti-HIV Agents
keywords: Combined antiretroviral therapy; Epidemiology; HIV; Hodgkin lymphoma; Non-AIDS defining cancer