Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX.
Section of Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, TX.
J Acquir Immune Defic Syndr. 2020 May 1;84(1):18-25. doi: 10.1097/QAI.0000000000002303.
Despite advances in diagnosis and treatment of both HIV and Burkitt lymphoma (BL), persons living with HIV remain at high risk for BL. We conducted this study to evaluate if there have been any changes in the risk of or survival after BL diagnosis among persons living with HIV during the antiretroviral era.
Veterans living with HIV (VLWH) and age-matched HIV-negative controls receiving care between 1999 and 2016 were retrospectively identified using Veterans Health Administration electronic medical records.
We identified BL diagnoses through Veterans Health Administration Cancer Registry review and International Classification of Diseases, Ninth/Tenth Revisions, codes, and we extracted demographic, lifestyle, and clinical variables from electronic medical record. We estimated hazard ratios (HR) and 95% confidence intervals (CIs) for BL risk and survival using Cox proportional models.
We identified 45,299 VLWH. Eighty-four developed BL (incidence rate = 21.2 per 100,000 person years; CI: 17.1 to 26.3). Median CD4 count at BL diagnosis was 238 cells per milliliter (SD: 324.74) and increased over time. Survival was truncated in VLWH with BL (P < 0.05). The risk of BL in VLWH was 38% less in blacks compared with whites (HR: 0.620; CI: 0.393 to 0.979; P = 0.0401). VLWH with an undetectable viral load for at least 40% of follow-up were 74% less likely to develop BL (HR: 0.261; CI: 0.143 to 0.478; P < 0.0001) and 86% less likely to die after diagnosis (HR: 0.141; CI: 0.058 to 0.348; P < 0.0001).
BL incidence among VLWH did not improve between 2000 and 2016. Survival after BL diagnosis in VLWH remains dismal as compared with their HIV-negative counterparts, although veterans with prolonged periods of undetectable viral load had improved prognosis.
尽管 HIV 和伯基特淋巴瘤（BL）的诊断和治疗都取得了进展，但 HIV 感染者仍面临着罹患 BL 的高风险。我们开展这项研究旨在评估在抗逆转录病毒时代，HIV 感染者罹患 BL 后的风险或生存是否发生了变化。
利用退伍军人事务部电子病历，回顾性地确定了在 1999 年至 2016 年间接受治疗的 HIV 感染者（VLWH）和年龄匹配的 HIV 阴性对照者。
我们通过退伍军人事务部癌症登记处的审查和国际疾病分类，第九/第十修订版代码来确定 BL 诊断，并从电子病历中提取人口统计学、生活方式和临床变量。我们使用 Cox 比例模型来估计 BL 风险和生存的风险比（HR）和 95%置信区间（CI）。
我们共确定了 45299 例 VLWH。其中 84 例罹患 BL（发病率为 21.2/100000 人年；95%CI：17.1 至 26.3）。BL 诊断时的中位 CD4 计数为 238 个细胞/毫升（标准差：324.74），且随时间推移而增加。BL 患者的生存时间被截断（VLWH 中 P<0.05）。与白人相比，黑人罹患 BL 的风险降低了 38%（HR：0.620；95%CI：0.393 至 0.979；P=0.0401）。有至少 40%的时间病毒载量无法检测到的 VLWH 患者，罹患 BL 的可能性降低了 74%（HR：0.261；95%CI：0.143 至 0.478；P<0.0001），且诊断后死亡的可能性降低了 86%（HR：0.141；95%CI：0.058 至 0.348；P<0.0001）。
VLWH 中的 BL 发病率在 2000 年至 2016 年期间并未改善。与 HIV 阴性对照者相比，VLWH 患者的 BL 诊断后生存仍然很差，尽管具有较长时间病毒载量无法检测的退伍军人预后有所改善。
