Antiretroviral therapy has not improved survival of HIV-associated lymphoma
Survival rates were stable for patients with HIV-associated lymphoma during the antiretroviral therapy (ART) era in the United States, according to a new study.
HIV infection is known to increase the risk for non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL), and the incidence for many lymphoma types has not decreased in the ART era. Moreover, lymphoma is the most frequent cancer-related cause of death among HIV-infected persons.
This study, conducted by Satish Gopal, MD, MPH, of the Lineberger Comprehensive Cancer Center at the University of North Carolina in Chapel Hill and colleagues, compared differences in presentation and survival, across histologic subtypes and diagnosis years, and among patients with HIV-infected lymphoma. Data were analyzed from 476 patients with various types of HIV-associated lymphomas that were diagnosed between 1996 and 2010. The study was published in the Journal of the National Cancer Institute (2013; doi: 10.1093/jnci/djt158).
The study found that HIV-associated lymphoma is heterogeneous and has been changing since the ART era began. Clinical presentations across the different lymphoma subtypes were highly variable during the study period. The proportion of Burkitt lymphoma versus other subtypes was increasing. More recently diagnosed patients were older and more likely to be male, to be of primarily Latino ethnicity, to be men who have sex with men, and to have prior AIDS-related illness. The patients with HIV-associated lymphoma were also more likely to be on ART at lymphoma diagnosis with higher CD4 counts and better HIV control.
The more recent diagnosis year was not associated with decreased mortality. Notably, lymphomas occurring while patients were on ART were associated with a doubling of mortality. This may suggest important biological differences between tumors developing on and off ART.An accompanying editorial stated that the study's findings reflect the shifting demographics of the HIV epidemic in the United States (JNCI 2013; doi:10.1093/jnci/djt192). However, the shift towards more biologically favorable and curable types of lymphoma has not resulted in improved survival over the study period. The editorial asserted that HIV-associated lymphomas are potentially as curable as those arising in HIV-negative patients, and that HIV-associated lymphomas should be approached with the same care as HIV-negative cases.