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Hodgkin lymphoma is as common as non‐ H odgkin lymphoma in HIV ‐positive patients with sustained viral suppression and limited immune deficiency: a prospective cohort study

2014; Wiley; Volume: 16; Issue: 4 Linguagem: Inglês

10.1111/hiv.12200

1468-1293

Christian Hoffmann, Marcus Hentrich, Daniel Gillor, Georg M. N. Behrens, Björn‐Erik Ole Jensen, Albrecht Stoehr, Stefan Eßer, Jan van Lunzen, Ivanka Krznaric, Markus Müller, Mark Oette, M. Hensel, Jan Thoden, Gerd Fätkenheuer, Christoph Wyen,

Lymphoma Diagnosis and Treatment

Objectives The incidence of HIV ‐related non‐ H odgkin lymphoma ( NHL ) but not that of H odgkin lymphoma ( HL ) has been declining. The aim of the study was to compare HIV ‐infected patients with NHL and HL with respect to antiretroviral therapy ( ART ) exposure at the time of lymphoma diagnosis. Methods HIV ‐infected patients with NHL and HL included in a prospective multicentre cohort study since J anuary 2005 were compared with respect to ART exposure and viral load at the time of lymphoma diagnosis. Results As of 31 D ecember 2012, data for 329 patients with NHL and 86 patients with HL from 31 participating centres were available. Patients with HL were more likely to be on ART (73.5% vs. 39.1%, respectively; P < 0.001) and more frequently had a viral load below the detection limit (57.3% vs. 27.9%, respectively; P < 0.001) than patients with NHL . The proportion of patients with HL was 8.0% in ART ‐naïve patients, 34.8% in patients with current HIV RNA < 50 HIV ‐1 RNA copies/mL, and 50.0% in patients with both HIV RNA < 50 copies/mL for > 12 months and a CD 4 cell count of > 200 cells/μL. Of note, 45.8% of all patients with NHL were not currently on ART and had a CD 4 count of < 350 cells/μL. Conclusions This prospective cohort study shows that HL was as common as NHL in patients with sustained viral suppression and limited immune deficiency. In contrast to NHL , the majority of patients with HL were on effective ART , suggesting that ART provides insufficient protection from developing HL . The high proportion of untreated patients with NHL suggests missed opportunities for earlier initiation of ART .