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Decreased Cases of and Improved Survival from AIDS-associated Non-Hodgkin's Lymphoma in the Era of Highly Active Antiretroviral Therapy
C Diamond*, T H Taylor, and H A Culver
Univ. of California, Irvine, USA
Background: We sought to determine how the availability of
highly active antiretroviral therapy (HAART) changed the epidemiology,
presentation, treatment and outcomes of AIDS-associated non-Hodgkin’s lymphoma
(NHL).
Methods: We performed a match between the AIDS and
cancer registries for San Diego
County. Registry data
were complete from 1988 to 2000. We defined the pre- and post-HAART periods as
1988 to 1995 and 1996 to 2000, respectively.
Results: Among 537 AIDS-NHL cases, 410 (76%) were
diagnosed pre-HAART and 127 (24%) were diagnosed post-HAART. The rate of NHL
among reported AIDS cases in San Diego decreased from 61.8 per 1000 in 1988 to
a nadir of 35.9 per 1000 in 2000 (r =
0.47, p = 0.11). This rate peaked in 1994 at 64.8 per 1000, as did the
number of AIDS-NHL cases (n = 65). Although
the number of AIDS-NHL cases gradually decreased each year from 1996 to 2000
(32 in 1996, 31 in 1997, 25 in 1998, 23 in 1999 and 16 in 2000), the concurrent
decrease in AIDS cases in San Diego moderated the decline in the rate of NHL
among reported AIDS cases. Among all NHL cases in San Diego, a greater percentage were
AIDS-related in the pre- vs post-HAART period (12.8% vs 5.5%, p <0.001).
Pre-HAART, 15% of AIDS-NHL patients were diagnosed with HIV after their NHL diagnosis
vs 8% post-HAART (p = 00.04). The median duration of diagnosed HIV infection was
shorter pre-HAART than post-HAART (21 vs 64 months, p <0.001).
Comparing the histology of cases diagnosed pre- and post-HAART, the percentage
of intermediate grade NHL increased from 27% to 43% and the percentage of high
grade NHL concomitantly decreased from 30% to 18% (p <0.01).
Pre-HAART, 41% of patients received chemotherapy vs 63% post-HAART (p
<0.001). Pre-HAART, 28% of patients had primary central nervous system
lymphoma vs 17% post-HAART (p = 0.01). Among systemic NHL cases, the
median CD4 count was 74/MCL pre-HAART vs 105/MCL post-HAART (p = 0.04).
Among CNS NHL cases, the median CD4 count was 20/MCL pre-HAART vs 22/MCL
post-HAART (p = 0.60). Among systemic NHL cases, the median survival was
4 months pre-HAART vs 9 months post-HAART (p <0.001). Among CNS NHL
cases, the median survival was 2 months pre-HAART vs one month post-HAART (p
= 0.39).
Conclusions: The number of AIDS-NHL cases decreased in San Diego County with the availability of HAART.
AIDS patients with systemic NHL survived longer in the post-HAART era,
presumably because of higher CD4 cell counts, less aggressive NHL disease and
treatment with chemotherapy.
Keywords: Non-Hodgkin's Lymphoma; Antiretroviral Therapy
