What is the role of antiretroviral therapy on the development of HIV-associated lymphoma?

The Bottom Line:  This large collaborative analysis of European HIV-1 cohort studies found that the incidence of HL was close to 50 new cases per 100 000 person-years of follow-up, independently of whether or not patients received cART. Few risk factors could be identified. For example, HIV-1 viral replication at baseline was not associated with the risk of HL. There was some evidence that patients who started cART with advanced clinical disease were at increased risk of HL and that patients with baseline CD4 cell counts of 100 to 199 cells/μL were at higher risk of developing HL than patients with lower or higher CD4 cell counts.

Reference: Bohlius J, Schmidlin K, Boué F, Fätkenheuer G, May M, Caro-Murillo AM, Mocroft A, Bonnet F, Clifford G, Paparizos V, Miro JM, Obel N, Prins M, Chêne G, Egger M;Collaboration of Observational HIV Epidemiological Research Europe.  HIV-1-related Hodgkin lymphoma in the era of combination antiretroviral therapy: incidence and evolution of CD4⁺ T-cell lymphocytes.  Blood. 2011 Jun 9;117(23):6100-8.

Summary: This large collaborative analysis of European HIV cohort studies showed that, in the era of cART, the incidence of HL is similar in patients receiving cART and patients not on cART. In HIV-infected patients, a decline of CD4 cell counts, which is not explained by virologic failure of cART, may herald the diagnosis of HL and should therefore alert clinicians to the possibility of a developing HL.

See also:

The Bottom Line: The risk of non-Hodgkin lymphoma increased for current plasma HIV RNA greater than 100,000 copies per mL compared with patients with controlled viral load.

Reference: Guiguet M, Boué F, Cadranel J, Lang JM, Rosenthal E, Costagliola D; Clinical Epidemiology Group of the FHDH-ANRS CO4 cohort. Effect of immunodeficiency, HIV viral load, and antiretroviral therapy on the risk of individual malignancies (FHDH-ANRS CO4): a prospective cohort study.  Lancet Oncol. 2009 Dec;10(12):1152-9.

Summary: cART (combination antiretroviral therap) would be most beneficial if it restores or maintains CD4 count above 500 cells per microL, thereby indicating an earlier diagnosis of HIV infection and an earlier treatment initiation. Cancer-specific screening programmes need to be assessed in patients with HIV.

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