Bohlius Julia, Schmidlin Kurt, Costagliola Dominique, Fätkenheuer Gerd, May Margaret, Caro-Murillo Anna Maria, Mocroft Amanda, Bonnet Fabrice, Clifford Gary, Karafoulidou Anastasia, Miro Jose M, Lundgren Jens, Chene Genevieve, Egger Matthias
Antivir Ther. 2009;14(8):1065-74. doi: 10.3851/IMP1462.
Incidence and risk factors of HIV-associated non-Hodgkin's lymphoma (NHL) are not well defined in the era of combination antiretroviral therapy (cART).
A total of 56,305 adult HIV type-1 (HIV-1)-infected patients who started cART in 1 of 22 prospective studies in Europe were included. Weibull random effects models were used to estimate hazard ratios (HRs) for developing systemic NHL and included CD4(+) T-cell counts and viral load as time-updated variables.
During the 212,042 person-years of follow-up, 521 patients were diagnosed with systemic NHL and 62 with primary brain lymphoma (PBL). The incidence rate of systemic NHL was 463 per 100,000 person-years not on cART and 205 per 100,000 person-years in treated patients for a rate ratio of 0.44 (95% confidence interval [CI] 0.37-0.53). The corresponding incidence rates of PBL were 57 and 24 per 100,000 person-years (rate ratio 0.43, 95% CI 0.25-0.73). Suppression of HIV-1 replication on cART (HR 0.60, 95% CI 0.44-0.81, comparing < or =500 with 10,000-99,999 copies/ml) and increases in CD4(+) T-cell counts (HR 0.30, 0.22-0.42, comparing > or =350 with 100-199 cells/microl) were protective; a history of Kaposi's sarcoma (HR 1.70, 1.08-2.68, compared to no history of AIDS), transmission through sex between men (HR 1.57, 1.19-2.08, compared with heterosexual transmission) and older age (HR 3.71, 2.37-5.80, comparing > or =50 with 16-29 years) were risk factors for systemic NHL.
The incidence rates of both systemic NHL and PBL were substantially reduced in patients on cART. Timely initiation of therapy is key to the prevention of NHL in the era of cART.
在联合抗逆转录病毒治疗（cART）时代，HIV相关非霍奇金淋巴瘤（NHL）的发病率和危险因素尚未明确。
纳入了欧洲22项前瞻性研究中1项研究里开始接受cART治疗的总共56305例成年HIV-1感染患者。使用威布尔随机效应模型来估计发生系统性NHL的风险比（HRs），并将CD4(+) T细胞计数和病毒载量作为随时间更新的变量。
在212042人年的随访期间，521例患者被诊断为系统性NHL，62例被诊断为原发性脑淋巴瘤（PBL）。未接受cART治疗的患者中系统性NHL的发病率为每100000人年463例，接受治疗患者中的发病率为每100000人年205例，发病率比为0.44（95%置信区间[CI] 0.37 - 0.53）。PBL的相应发病率分别为每100000人年57例和24例（发病率比0.43，95% CI 0.25 - 0.73）。cART治疗中HIV-1复制的抑制（HR 0.60，95% CI 0.44 - 0.81，比较<或=500拷贝/ml与10000 - 99999拷贝/ml）以及CD4(+) T细胞计数的增加（HR 0.30，0.22 - 0.42，比较>或=350细胞/μl与100 - 199细胞/μl）具有保护作用；卡波西肉瘤病史（HR 1.70，1.08 - 2.68，与无艾滋病病史相比）、男性间性传播（HR 1.57，1.19 - 2.08，与异性传播相比）和年龄较大（HR 3.71，2.37 - 5.80，比较>或=50岁与16 - 29岁相比）是系统性NHL的危险因素。
接受cART治疗的患者中系统性NHL和PBL的发病率均大幅降低。在cART时代，及时开始治疗是预防NHL的关键。
