Bonnet Fabrice, Balestre Eric, Thiébaut Rodolphe, Morlat Philippe, Pellegrin Jean-Luc, Neau Didier, Dabis François
Service de Medecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France.
Clin Infect Dis. 2006 Feb 1;42(3):411-7. doi: 10.1086/499054. Epub 2005 Dec 27.
High grade non-Hodgkin lymphoma (NHL) remains the most common Acquired Immune Deficiency Syndrome (AIDS)-associated neoplasia and an important cause of mortality in people living with human immunodeficiency virus (HIV) infection in industrialized countries in the era of highly active antiretroviral therapy (HAART).
A case-control study was implemented in a large cohort of HIV-infected patients. Case patients had newly diagnosed NHL, and control subjects were matched for CD4(+) cell count, calendar period, sex, and length of follow-up.
Variables associated with a decreased risk of NHL were the use of HAART during follow-up for at least 6 months (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-0.98), receipt of a diagnosis of AIDS before the censoring date (OR, 0.37; 95% CI, 0.18-0.76), and undetectable level of HIV RNA during follow-up (OR, 0.34; 95% CI, 0.15-0.77). The use of antiherpetic drug for at least 6 months was associated with a nonsignificant decreased risk of NHL (OR, 0.40; 95% CI, 0.11-1.44; P=.16). In multivariate analysis, variables significantly associated with a decreased risk of NHL were the use of HAART for at least 6 months during follow-up (OR, 0.37; 95% CI, 0.16-0.87) and receipt of an AIDS-related diagnosis before the censoring date (OR, 0.44; 95% CI, 0.21-0.93). Age, transmission group, hepatitis B and C coinfections, CD4(+) and CD8(+) cell count nadir, and previous history of herpes virus infection were not associated with an increased risk for NHL.
The use of HAART for at least 6 months was associated with a decreased risk of NHL, whereas uncontrolled HIV RNA load may be associated with an increased risk. The role of antiherpetic drugs needs further investigation.
在高效抗逆转录病毒治疗（HAART）时代，高级别非霍奇金淋巴瘤（NHL）仍是工业化国家中最常见的获得性免疫缺陷综合征（AIDS）相关肿瘤，也是人类免疫缺陷病毒（HIV）感染者死亡的重要原因。
在一大群HIV感染患者中开展了一项病例对照研究。病例患者为新诊断的NHL患者，对照对象则根据CD4(+)细胞计数、日历时间段、性别和随访时长进行匹配。
与NHL风险降低相关的变量包括随访期间使用HAART至少6个月（比值比[OR]，0.46；95%置信区间[CI]，0.21 - 0.98）、在审查日期之前获得AIDS诊断（OR，0.37；95% CI，0.18 - 0.76）以及随访期间HIV RNA水平检测不到（OR，0.34；95% CI，0.15 - 0.77）。使用抗疱疹药物至少6个月与NHL风险降低无显著关联（OR，0.40；95% CI，0.11 - 1.44；P = 0.16）。在多变量分析中，与NHL风险降低显著相关的变量包括随访期间使用HAART至少6个月（OR，0.37；95% CI，0.16 - 0.87）以及在审查日期之前获得AIDS相关诊断（OR，0.44；95% CI，0.21 - 0.93）。年龄、传播途径、乙型和丙型肝炎合并感染、CD4(+)和CD8(+)细胞计数最低点以及既往疱疹病毒感染史与NHL风险增加无关。
使用HAART至少6个月与NHL风险降低相关，而未控制的HIV RNA载量可能与风险增加相关。抗疱疹药物的作用需要进一步研究。
