title: Contributions of HIV to Non-Hodgkin Lymphoma Mortality Trends in the United States.
abstract: The human immunodeficiency virus (HIV) epidemic has strongly influenced non-Hodgkin lymphoma (NHL) incidence in the U.S. general population, but its effects on NHL mortality trends are unknown.
  
  
  
  Using SEER cancer registry data, we assessed NHL mortality rates in the United States (2005-2012) and mapped NHL deaths to prior incident cases. Data included HIV status at NHL diagnosis. We describe the proportion of NHL deaths linked to an HIV-infected case, for 3 AIDS-defining subtypes [diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, and central nervous system (CNS) lymphoma] and within demographic categories. We also present incidence-based mortality (IBM) rates showing the impact of HIV on mortality trends and describe survival after NHL diagnosis by calendar year.
  
  
  
  Of 11,071 NHL deaths, 517 (4.6%) were in HIV-infected persons. This proportion was higher in deaths mapped to DLBCL (7.3% with HIV), Burkitt lymphoma (33.3%), and CNS lymphoma (17.6%), and among deaths from these subtypes, for people aged 20-49 years (46.6%), males (15.2%), and blacks (39.3%). IBM rates declined steeply during 2005-2012 for HIV-infected NHL cases (-7.6% per year, P = 0.001). This trend reflects a steep decline in incident NHL among HIV-infected people after 1996, when highly active antiretroviral therapy was introduced. Five-year cancer-specific survival improved more markedly among HIV-infected cases (9%-54%) than HIV-uninfected cases (62%-76%) during 1990-2008.
  
  
  
  The HIV epidemic has strongly contributed to NHL deaths, especially for AIDS-defining NHL subtypes and groups with high HIV prevalence.
  
  
  
  Declining NHL mortality rates for HIV-infected cases reflect both declining incidence and improving survival. Cancer Epidemiol Biomarkers Prev; 25(9); 1289-96. ©2016 AACR.
authors.affiliation: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland. Department of Epidemiology and Biostatistics, The George Washington University Milken Institute School of Public Health, Washington, D.C. howladern@mail.nih.gov.
authors.forename: Nadia
authors.initials: N
authors.lastname: Howlader
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda Maryland.
authors.forename: Meredith S
authors.initials: MS
authors.lastname: Shiels
authors.affiliation: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Mariotto
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda Maryland.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D002051:Burkitt Lymphoma / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D016483:Lymphoma, AIDS-Related / Q000401:mortality* / Q000821:virology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D055815:Young Adult