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Risk of non-Hodgkin Lymphoma Death Still Higher With HIV Infection
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16th Conference on Retroviruses and Opportunistic Infections,
February 8-11, 2009, Montreal
Mark Mascolini
Despite improvements in antiretroviral therapy, HIV-infected people with non-Hodgkin lymphoma (NHL) still have a higher 2-year all-cause death rate than NHL patients without HIV, according to results of a 10,000-person study in California's Kaiser Permanente health system [1]. Kaiser investigators confirmed the higher death rate with HIV regardless of NHL subtype or stage--and even though more people with HIV got chemotherapy earlier after their diagnosis than people without HIV.
Combing through their 6-million patient database, Kaiser investigators identified 268 people with HIV and 8203 without HIV who were diagnosed with NHL from 1996 through 2005. Among people with HIV, NHL diagnoses were distributed fairly evenly over three periods--29.9% in 1996-1999, 39.6% in 2000-2002, and 30.6% in 2003-2005. A significantly higher proportion of HIV-infected people than HIV-uninfected controls started chemotherapy in the first 4 months after their NHL diagnosis (66.8% versus 57.3%, P < 0.01).
In both the HIV and the non-HIV groups, about half of NHLs were in stage 3 or 4 at diagnosis. Among people with HIV, the most common NHLs were diffuse large B-cell lymphoma (62%) and Burkitt's lymphoma (16%).
Two years after diagnosis, age-adjusted mortality stood at 58.6% in people with HIV and 18.5% in people without HIV. Mortality was higher with HIV in all three periods considered: 60.0% versus 31.9% in 1996-1999, 63.2% versus 27.7% in 2000-2002, and 51.2% versus 28.9% in 2003-2005. And people with HIV had a higher 2-year death rate regardless of NHL stage at diagnosis: 58.6% versus 17.0% for stage 1, 53.2% versus 27.6% for stage 2, 60.1% versus 36.0% for stage 3 and 4, and 60.0% versus 39.5% for unstaged NHL. Two-year mortality was significantly higher in HIV-infected people who did not receive chemotherapy within 4 months of NHL diagnosis (76.4%) than in those who did (49.7%) (P < 0.01).
In an analysis adjusted for age, gender, race/ethnicity, NHL stage, and year of diagnosis, HIV infection raised the risk of all-cause 2-year mortality almost 6 times (odds ratio [OR] 5.93, 95% confidence interval [CI] 4.52 to 7.78, P < 0.01). Risk of death 2 years after diagnosis was higher in the HIV group for stage 1 and 2 NHL (OR 8.57, 95% CI 5.59 to 13.14, P < 0.01) and for stage 3 and 4 NHL (OR 4.88, 95% CI 2.92 to 8.15, P < 0.01) People with HIV and diffuse large B-cell lymphoma had almost a 3 times higher 2-year death risk than HIV-negative controls (OR 2.97, 95% CI 2.09 to 4.23, P < 0.01), and people with Burkitt's lymphoma and HIV had almost a 5 times higher death risk (OR 4.73, 95% CI 1.66 to 13.56, P < 0.01).
Risk of all-cause mortality in people with HIV versus those without HIV actually became greater with an NHL diagnosis in the more recent combination antiretroviral era (2000-2005, OR 6.37, 95% CI 4.62 to 8.79, P < 0.01) than in the early combination antiretroviral era (1996-1999, OR 4.84, 95% CI 2.90 to 8.06, P < 0.01).
Reference
1. Chao Chun, Xu Lanfang, Abrams D, et al. Prognosis of non-Hodgkin lymphoma in HIV-infected patients. 16th Conference on Retroviruses and Opportunistic Infections, February 8-11, 2009, Montreal. Abstract 871.
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