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HAART Is Not Associated with an Increased Risk of Hodgkin Lymphoma in HIV-infected Patients
Fabrice Bonnet*1, K Petoumenos2, A Calmy3, C Lewden1, J Hoy4, F Dabis1, S Herbert4, P Morlat1, A Carr3, M Law2, and the Aquitaine Cohort and the Australian HIV Observationnal Database
1INSERM U593, Univ Bordeaux 2, France; 2Natl Ctr for HIV Epidemiology and Clin Res, Univ of New South Wales, Australia; 3St Vincent's Hosp, Sydney, Australia; and 4Alfred Hosp, Melbourne, Australia
Background: Epidemiological studies have demonstrated an increased
risk of Hodgkin lymphoma in HIV-infected patients before the era of HAART.
However, the incidence of Hodgkin lymphoma is increasing since the use of HAART,
despite the general improvement in the immune status. The role of HAART in the
risk of occurrence of Hodgkin lymphoma should be explored.
Methods: A nested inter-cohort, case-control study was
implemented in 2 large cohorts of HIV-infected patients (Aquitaine Cohort,
France and AHOD, Australia).
Cases had newly diagnosed Hodgkin lymphoma, and controls were matched on a 1:2 ratio for center, CD4 cell count, calendar year of
diagnosis, and follow-up duration. Matched odds ratios were
calculated.
Results: We recruited 41 cases (including 40 men) and
matched them with 82 controls. Cases were confirmed by histopathology: mixed cellularity
39%, nodular sclerosis 15%, lymphocyte depleted 10%, not categorized 37%. At
the time of Hodgkin lymphoma diagnosis, median age of patients was 39 years (interquartile range IQR, 35 to 45), median time of
follow-up was 11.7 years (IQR 6.8 to 13.2), median CD4 cell count 241/mm3 (IQR 160 to 447), and CD8 cell
count 713/mm3 (IQR 400 to 940), median CD4 nadir 145/mm3, (IQR 99 to 295), median HIV RNA
500 copies/mL (IQR 500 to 15,494). HIV transmission
groups were men who have sex with men 60%, heterosexual 21%, intravenous drug
users 13%. Prior AIDS diagnoses occurred in 24% of cases, 25% had hepatitis C
antibodies, and 8% had HBs antigen. At the time of Hodgkin
lymphoma diagnosis, 76% of patients were receiving HAART. Median duration of ART
was 44 months, including 24 months on HAART. Age, CD4 cell count nadir,
duration with CD4 cell count below 200/mm3, HIV RNA at the time of match
date, duration with HIV RNA < 500 copies/mL,
hepatitis C or B co-infection, stage of HIV infection, total duration of ART
and of HAART were not associated with an increased risk of Hodgkin lymphoma (all
p values >0.3).
Conclusions: Despite an increased incidence since the
introduction of HAART, the occurrence of Hodgkin lymphoma does not appear to be
associated with the use of ART, uncontrolled HIV replication, or CD4 cell
nadir. Other factors, such as control of Epstein Barr virus (EBV) infection,
immune stimulation, and altered qualitative immune functions less likely
controlled by the use of ARTmay explain this
increasing incidence.
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