Achenbach Chad J, Buchanan Ashley L, Cole Stephen R, Hou Lifang, Mugavero Michael J, Crane Heidi M, Moore Richard D, Haubrich Richard H, Gopal Satish, Eron Joseph J, Hunt Peter W, Rodriguez Benigno, Mayer Kenneth, Saag Michael S, Kitahata Mari M
Department of Medicine, Center for Global Health, and The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
Clin Infect Dis. 2014 Jun;58(11):1599-606. doi: 10.1093/cid/ciu076. Epub 2014 Feb 12.
The incidence of non-Hodgkin lymphoma (NHL) in human immunodeficiency virus (HIV)-infected patients remains high despite treatment with antiretroviral therapy (ART).
We evaluated NHL incidence in HIV-infected patients followed in the Centers for AIDS Research Network of Integrated Clinical Systems who started combination ART and achieved suppression of HIV. We estimated the hazard ratio for NHL by time-varying HIV viremia categories, accounting for time-varying CD4 cell count using marginal structural models.
We observed 37 incident NHL diagnoses during 21 607 person-years of follow-up in 6036 patients (incidence rate, 171 per 100 000 person-years; 95% confidence interval [CI], 124-236). NHL incidence was high even among patients with nadir CD4 cell count >200 cells/µL (140 per 100 000 person-years [95% CI, 80-247]). Compared with ≤50 copies/mL, hazard ratios (HRs) for NHL were higher among those with HIV viremia of 51-500 copies/mL (HR current = 1.66 [95% CI, .70-3.94]; HR 3-month lagged = 2.10 [95% CI, .84-5.22]; and HR 6-month lagged = 1.46 [95% CI, .60-3.60]) and >500 copies/mL (HR current = 2.39 [95% CI, .92-6.21]; HR 3-month lagged = 3.56 [95% CI, 1.21-10.49]; and HR 6-month lagged = 2.50 [95% CI, .91-6.84]). Current HIV RNA as a continuous variable was also associated with NHL (HR = 1.42 per log10 copies/mL [95% CI, 1.05-1.92]).
Our findings demonstrate a high incidence of NHL among HIV-infected patients on ART and suggest a role of HIV viremia in the pathogenesis of NHL. Earlier initiation of potent ART and maximal continuous suppression of HIV viremia may further reduce NHL risk.
尽管接受了抗逆转录病毒疗法（ART）治疗，但人类免疫缺陷病毒（HIV）感染患者中非霍奇金淋巴瘤（NHL）的发病率仍然很高。
我们评估了综合临床系统艾滋病研究网络中接受治疗的HIV感染患者的NHL发病率，这些患者开始接受联合ART治疗并实现了HIV抑制。我们使用边际结构模型，通过随时间变化的HIV病毒血症类别估计NHL的风险比，并考虑随时间变化的CD4细胞计数。
在6036例患者的21607人年随访期间，我们观察到37例NHL确诊病例（发病率为每100000人年171例；95%置信区间[CI]，124 - 236）。即使在最低点CD4细胞计数>200个/μL的患者中，NHL发病率也很高（每100000人年140例[95%CI，80 - 247]）。与≤50拷贝/mL相比，HIV病毒血症为51 - 500拷贝/mL的患者发生NHL的风险比（HR）更高（当前HR = 1.66 [95%CI，0.70 - 3.94]；3个月滞后HR = 2.10 [95%CI，0.84 - 5.22]；6个月滞后HR = 1.46 [95%CI，0.60 - 3.60]），病毒血症>500拷贝/mL的患者风险比更高（当前HR = 2.39 [95%CI，0.92 - 6.21]；3个月滞后HR = 3.56 [95%CI，1.21 - 10.49]；6个月滞后HR = 2.50 [95%CI，0.91 - 6.84]）。将当前HIV RNA作为连续变量分析时，其也与NHL相关（每log10拷贝/mL的HR = 1.42 [95%CI，1.05 - 1.92]）。
我们的研究结果表明，接受ART治疗的HIV感染患者中NHL发病率很高，并提示HIV病毒血症在NHL发病机制中起作用。更早开始强效ART治疗并最大程度持续抑制HIV病毒血症可能会进一步降低NHL风险。
