Temporal Trends in Presentation and Survival for HIV-Associated Lymphoma in the Antiretroviral Therapy Era
Temporal Trends in Presentation and Survival for HIV-Associated Lymphoma in the Antiretroviral Therapy Era
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DOI：
10.1093/jnci/djt158
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发表时间：
2013-08-01
影响因子：
10.3
通讯作者：
Richards, Kristy L.
中科院分区：
文献类型：
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作者：
Gopal, Satish;Patel, Monita R.;Richards, Kristy L.
淋巴瘤是抗逆转录病毒治疗 (ART) 时代 HIV 感染者癌症相关死亡的主要原因。我们研究了 1996 年至 2010 年综合临床系统艾滋病研究网络中心的淋巴瘤患者。我们检查了按组织学和诊断年份分层的差异。使用 KaplanMeier 曲线和 Cox 比例风险分析死亡率和死亡预测因子。在 23 050 名 HIV 感染者中，476 名 (2.1%) 患上淋巴瘤（79 [16.6%] 霍奇金淋巴瘤 [HL]；201 [42.2%] 弥漫性大 B 细胞淋巴瘤 [DLBCL]；56 [11.8%] 伯基特淋巴瘤 [BL]；54 [11.3%] 原发性中枢神经系统淋巴瘤 [PCNSL]；以及 86 [18.1%] 其他非霍奇金淋巴瘤 [NHL]）。诊断时，HL 患者比 NHL 患者具有更高的 CD4 计数和更低的 HIV RNA。 NHL 类别中 PCNSL 患者的 CD4 计数最低，BL 患者的 CD4 计数最高。在研究期间，淋巴瘤诊断时的 CD4 计数逐渐增加，而 HIV RNA 减少。 HL 的五年生存率为 61.6%，BL 为 50.0%，DLBCL 为 44.1%，其他 NHL 为 43.3%，PCNSL 为 22.8%。死亡率与年龄（调整后风险比[AHR]每十年增加1.28，95%置信区间[CI]1.06至1.54）、ART治疗后淋巴瘤发生率（AHR 2.21，95% CI 1.53至3.20）、CD4计数（AHR每增加100个细胞/L 0.81，95% CI 0.72至0.90)、HIV RNA（AHR 1.13/log(10)copies/mL，95% CI 1.00 至 1.27）和组织学，但不是早期诊断年份。HIV 相关淋巴瘤具有异质性和变化性，诊断时免疫抑制较少，HIV 控制较好。接受 ART 治疗的淋巴瘤的稳定生存和死亡率增加需要更深入的生物学见解来改善预后。
Lymphoma is the leading cause of cancer-related death among HIV-infected patients in the antiretroviral therapy (ART) era.We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems from 1996 until 2010. We examined differences stratified by histology and diagnosis year. Mortality and predictors of death were analyzed using KaplanMeier curves and Cox proportional hazards.Of 23 050 HIV-infected individuals, 476 (2.1%) developed lymphoma (79 [16.6%] Hodgkin lymphoma [HL]; 201 [42.2%] diffuse large B-cell lymphoma [DLBCL]; 56 [11.8%] Burkitt lymphoma [BL]; 54 [11.3%] primary central nervous system lymphoma [PCNSL]; and 86 [18.1%] other non-Hodgkin lymphoma [NHL]). At diagnosis, HL patients had higher CD4 counts and lower HIV RNA than NHL patients. PCNSL patients had the lowest and BL patients had the highest CD4 counts among NHL categories. During the study period, CD4 count at lymphoma diagnosis progressively increased and HIV RNA decreased. Five-year survival was 61.6% for HL, 50.0% for BL, 44.1% for DLBCL, 43.3% for other NHL, and 22.8% for PCNSL. Mortality was associated with age (adjusted hazard ratio [AHR] 1.28 per decade increase, 95% confidence interval [CI] 1.06 to 1.54), lymphoma occurrence on ART (AHR 2.21, 95% CI 1.53 to 3.20), CD4 count (AHR 0.81 per 100 cell/L increase, 95% CI 0.72 to 0.90), HIV RNA (AHR 1.13 per log(10)copies/mL, 95% CI 1.00 to 1.27), and histology but not earlier diagnosis year.HIV-associated lymphoma is heterogeneous and changing, with less immunosuppression and greater HIV control at diagnosis. Stable survival and increased mortality for lymphoma occurring on ART call for greater biologic insights to improve outcomes.