Bhaskaran Krishnan, Brettle Ray, Porter Kholoud, Walker A Sarah
MRC Clinical Trials Unit, 222 Euston Road, London NW1 2DA, UK.
AIDS. 2004 Mar 5;18(4):673-81. doi: 10.1097/00002030-200403050-00012.
To investigate temporal changes in the risk of non-Hodgkin lymphoma (NHL) and estimate NHL incidence in risk groups and the prognostic role of these risks and current, nadir and time-weighted average CD4 cell count.
Secular trends in time from HIV seroconversion to an NHL diagnosis was estimated using Cox models from data pooled from the 22 seroconverter cohorts in the CASCADE collaboration for three periods (pre-1997, 1997-1998, 1999-2002), adjusting for age at seroconversion, exposure category and sex.
Of 7103 seroconverters, 129 developed NHL. Compared with pre-1997, there was little reduction in NHL risk in 1997-1998 [relative risk (RR), 0.66; 95% confidence interval (CI), 0.37-1.17] then a substantial reduction in 1999-2002 (RR, 0.25, 95% CI, 0.12-0.53). Compared with individuals with CD4 cell count > 350 x 10 cells/l, the RR of NHL increased to 1.9 (95% CI, 1.0-3.6), 1.4 (95% CI, 0.6-3.5) and 11.2 (95% CI, 6.3-20.0) at CD4 cell counts 200-349, 100-199 and < 100 x 10 cells/l, respectively. There was no evidence that nadir (P = 0.41) or time-weighted average CD4 cell count (P = 0.38) contributed further to predicting NHL risk or were better predictors than current CD4 cell count. For individuals with CD4 cell count > 350 x 10 cells/l pre-HAART, an NHL incidence of 1.8 and 0.4/1000 person-years was estimated for those at highest and lowest risk, respectively, when classified by age and exposure category.
There appears to be no justification for initiating HAART at CD4 cell counts > 100 x 10 cells/l based specifically on concerns over NHL. The risk of NHL is, however, greatly increased at lower CD4 cell counts.
研究非霍奇金淋巴瘤（NHL）风险的时间变化，估计风险组中的NHL发病率，以及这些风险和当前、最低点及时间加权平均CD4细胞计数的预后作用。
利用来自CASCADE合作项目中22个血清转化队列的数据汇总，通过Cox模型估计从HIV血清转化到NHL诊断的时间的长期趋势，分为三个时期（1997年前、1997 - 1998年、1999 - 2002年），并对血清转化时的年龄、暴露类别和性别进行调整。
在7103名血清转化者中，129人患NHL。与1997年前相比，1997 - 1998年NHL风险几乎没有降低[相对风险（RR），0.66；95%置信区间（CI），0.37 - 1.17]，而在1999 - 2002年大幅降低（RR，0.25，95%CI，0.12 - 0.53）。与CD4细胞计数>350×10⁶个/升的个体相比，当CD4细胞计数分别为200 - 349、100 - 199和<100×10⁶个/升时，NHL的RR分别增加到1.9（95%CI，1.0 - 3.6）、1.4（95%CI，0.6 - 3.5）和11.2（95%CI，6.3 - 20.0）。没有证据表明最低点（P = 0.41）或时间加权平均CD4细胞计数（P = 0.38）对预测NHL风险有进一步贡献，也没有证据表明它们比当前CD4细胞计数是更好的预测指标。对于HAART前CD4细胞计数>350×10⁶个/升的个体，按年龄和暴露类别分类时，估计最高风险和最低风险者的NHL发病率分别为1.8和0.4/1000人年。
仅基于对NHL的担忧，在CD4细胞计数>100×10⁶个/升时开始HAART似乎没有依据。然而，在较低的CD4细胞计数时，NHL的风险会大大增加。
