根据抗逆转录病毒治疗时代的 HIV 状况比较坦桑尼亚霍奇金淋巴瘤的临床特征和治疗结局。

A comparison of clinical profile and treatment outcome of Hodgkin's Lymphoma in Tanzania according to HIV status during the HAART era.

机构信息

Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.

Department of Oncology, Longisa County Referral Hospital, Bomet, Kenya.

出版信息

BMC Cancer. 2024 Jul 3;24(1):796. doi: 10.1186/s12885-024-12569-z.

DOI:10.1186/s12885-024-12569-z

PMID:38961368

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11220972/

Abstract

BACKGROUND

The incidence of Hodgkin's lymphoma (HL) in people living with HIV (PLWHA) and on HAART is approximately 20-30 times higher than in HIV-negative individuals. Most patients with HIV-HL present at an advanced stage (III-IV) have 'B' symptoms and extranodal involvement. The natural history and risk stratification of HIV-HL has undergone a significant change as a result of HAART's rollout. This study investigated the differences in clinicopathological and survival patterns of HL among individuals with and without HIV disease in Tanzania during the HAART era.

METHODOLOGY

This hospital-based retrospective cohort study was conducted at the ORCI, Dar-Es-Salaam, Tanzania. Chi-square and Fisher's exact tests were used to compare proportions. The student t-test was used to compare means. To determine factors that predict survival, we used the log-rank test to analyze the variables in univariate analysis. A Cox regression model was used to analyze the significant factors from univariate analysis in multivariate analysis.

RESULTS

Eighty-three patients with HL were recruited, and the prevalence of HIV-positive status was 27.7%. Most of the patients with HIV-HL had an age of > 30 years (73.9%), while most of the non-HIV-HL patients had an age of ≤ 30 years (63.3%) (P = 0.02). The 2-year OS rate for HIV-HL was 34%, while that for non-HIV-HL was 67%. Among the HIV-HL patients, predictors of a poorer outcome were a CD4 count ≤ 200 cells/mm3 (P = 0.05), lack of HAART use (P = 0.00), and the use of HAART for ≤ 10 months (P = 0.00).

CONCLUSION

The prevalence of HIV-HL was 27.7% among HL patients. HIV positivity is still a poor prognostic factor in our setting, especially for patients not on HAART, on HAART for ≤ 10 months, or with a low CD4 count below 200 cells/mm3. Patients with HIV-HL were older and had higher LDH levels, whereas patients with non-HIV-HL were younger and had low LDH levels.

摘要

背景

HIV 感染者（PLWHA）和接受高效抗逆转录病毒治疗（HAART）的霍奇金淋巴瘤（HL）的发病率比 HIV 阴性个体高约 20-30 倍。大多数 HIV-HL 患者在晚期（III-IV 期）出现“B”症状和结外累及。随着 HAART 的普及，HIV-HL 的自然史和风险分层发生了显著变化。本研究旨在调查坦桑尼亚 HIV 时代 HIV 阳性和 HIV 阴性 HL 患者的临床病理和生存模式差异。

方法

这是一项在坦桑尼亚达累斯萨拉姆的 ORCI 进行的基于医院的回顾性队列研究。使用卡方检验和 Fisher 确切检验比较比例。使用学生 t 检验比较平均值。为了确定预测生存的因素，我们使用对数秩检验对单变量分析中的变量进行分析。使用 Cox 回归模型对多变量分析中的显著因素进行分析。

结果

共纳入 83 例 HL 患者，HIV 阳性率为 27.7%。大多数 HIV-HL 患者年龄大于 30 岁（73.9%），而大多数非 HIV-HL 患者年龄小于或等于 30 岁（63.3%）（P=0.02）。HIV-HL 的 2 年 OS 率为 34%，而非 HIV-HL 的 2 年 OS 率为 67%。在 HIV-HL 患者中，CD4 计数≤200 个细胞/mm3（P=0.05）、未使用 HAART（P=0.00）和使用 HAART≤10 个月（P=0.00）是预后较差的预测因素。

结论

在 HL 患者中，HIV-HL 的患病率为 27.7%。在我们的环境中，HIV 阳性仍然是一个不良预后因素，特别是对于未接受 HAART、接受 HAART≤10 个月或 CD4 计数低于 200 个细胞/mm3 的患者。HIV-HL 患者年龄较大，LDH 水平较高，而非 HIV-HL 患者年龄较小，LDH 水平较低。