aUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina bNorthwestern University, Chicago, Illinois cUniversity of Alabama at Birmingham, Birmingham, Alabama dUniversity of California at San Diego, San Diego, California eCase Western Reserve University, Cleveland, Ohio fUniversity of California at San Francisco, San Francisco, California gFenway Health, Boston, Massachusetts hJohns Hopkins University, Baltimore, Maryland iUniversity of Washington, Seattle, Washington, USA. *Satish Gopal and Monita R. Patel contributed equally to the writing of the study.
AIDS. 2013 Sep 24;27(15):2365-73. doi: 10.1097/QAD.0b013e3283635232.
To examine the association between early HIV viremia and mortality after HIV-associated lymphoma.
Multicenter observational cohort study.
Center for AIDS Research Network of Integrated Clinical Systems cohort.
HIV-infected patients with lymphoma diagnosed between 1996 and 2011, who were alive 6 months after lymphoma diagnosis and with at least two HIV RNA values during the 6 months after lymphoma diagnosis.
Cumulative HIV viremia during the 6 months after lymphoma diagnosis, expressed as viremia copy-6-months.
All-cause mortality between 6 months and 5 years after lymphoma diagnosis.
Of 224 included patients, 183 (82%) had non-Hodgkin lymphoma (NHL) and 41 (18%) had Hodgkin lymphoma. At lymphoma diagnosis, 105 (47%) patients were on antiretroviral therapy (ART), median CD4⁺ cell count was 148 cells/μl (interquartile range 54-322), and 33% had suppressed HIV RNA (<400 copies/ml). In adjusted analyses, mortality was associated with older age [adjusted hazard ratio (AHR) 1.37 per decade increase, 95% CI 1.03-1.83], lymphoma occurrence on ART (AHR 1.63, 95% CI 1.02-2.63), lower CD4⁺ cell count (AHR 0.75 per 100 cells/μl increase, 95% CI 0.64-0.89), and higher early cumulative viremia (AHR 1.35 per log₁₀ copies × 6-months/ml, 95% CI 1.11-1.65). The detrimental effect of early cumulative viremia was consistent across patient groups defined by ART status, CD4⁺ cell count, and histology.
Exposure to each additional 1-unit log₁₀ in HIV RNA throughout the 6 months after lymphoma diagnosis was associated with a 35% increase in subsequent mortality. These results suggest that early and effective ART during chemotherapy may improve survival.
探讨 HIV 相关淋巴瘤后早期 HIV 病毒血症与死亡率之间的关系。
多中心观察性队列研究。
艾滋病研究中心网络综合临床系统队列。
1996 年至 2011 年间诊断为淋巴瘤的 HIV 感染者，在淋巴瘤诊断后 6 个月内存活且在淋巴瘤诊断后 6 个月内至少有两次 HIV RNA 值。
在淋巴瘤诊断后 6 个月内的累积 HIV 病毒血症，以病毒载量 6 个月表示。
淋巴瘤诊断后 6 个月至 5 年内的全因死亡率。
在 224 名纳入的患者中，183 名（82%）患有非霍奇金淋巴瘤（NHL），41 名（18%）患有霍奇金淋巴瘤。在淋巴瘤诊断时，105 名（47%）患者正在接受抗逆转录病毒治疗（ART），中位 CD4⁺细胞计数为 148 个/μl（四分位距 54-322），33%的患者 HIV RNA 得到抑制（<400 拷贝/ml）。在调整后的分析中，死亡率与年龄较大（每增加十年的调整后危险比 [AHR] 为 1.37，95%CI 为 1.03-1.83）、ART 时发生淋巴瘤（AHR 为 1.63，95%CI 为 1.02-2.63）、较低的 CD4⁺细胞计数（AHR 为每增加 100 个/μl 增加 0.75，95%CI 为 0.64-0.89）和较高的早期累积病毒血症（AHR 为每增加 1 个对数₁₀ 拷贝×6 个月/ml 增加 1.35，95%CI 为 1.11-1.65）相关。早期累积病毒血症的有害作用在根据 ART 状态、CD4⁺细胞计数和组织学定义的患者群体中是一致的。
在淋巴瘤诊断后 6 个月内，HIV RNA 每增加 1 个单位的对数₁₀，随后的死亡率就会增加 35%。这些结果表明，在化疗期间早期和有效的 ART 可能会提高生存率。
