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Characteristics of non-Hodgkin lymphoma arising in HIV-infected patients with suppressed HIV replication

Gérard, Laurencea; Meignin, Véroniqueb; Galicier, Lionela; Fieschi, Clairea; Leturque, Nicolasa; Piketty, Christophec; Fonquernie, Laurentd; Agbalika, Felixe; Oksenhendler, Erica

doi: 10.1097/QAD.0b013e328330f62d
Clinical Science

Objective: Despite effective treatment of HIV infection, some patients still develop non-Hodgkin lymphoma (NHL). We analysed patients with HIV-associated NHL and undetectable plasma HIV-RNA, according to the duration of HIV suppression.

Methods: Out of 388 patients included in a prospective cohort of HIV-associated NHL from 1996 to 2008, 128 (33%) had a plasma HIV-RNA below 500 copies/ml and were included in the study. Patients with long-term HIV suppression (>18 months) were compared with patients with recent HIV suppression (≤18 months).

Results: All patients but three were treated with combination antiretroviral therapy, with a median duration of 2.2 years. The median duration of HIV suppression was 10.1 months. Most cases (65%) occurred within 18 months following HIV suppression. In the more than 18 months group, patients developed NHL at a higher CD4 cell count than patients with 18 months or less of HIV suppression (359 versus 270 cells/μl, P = 0.02). None of the NHL characteristics were different between the two groups. Outcome was similar in the two groups (complete remission, 64 versus 72.5%; P = 0.35 and 3-year survival, 46 versus 56%; P = 0.08). In addition, 52% of the tumours were Epstein–Barr virus or human herpesvirus 8 associated, without any difference in the proportion of virus-associated tumours according to the duration of HIV suppression.

Conclusion: In patients with undetectable HIV-RNA, NHL occurred mainly within the first 18 months following HIV suppression. In patients developing NHL after long-term HIV suppression, the level of CD4 cell count was higher, but the association with Epstein–Barr virus or human herpesvirus 8 and the prognosis were similar to that observed in patients with recent HIV suppression.

aService d'Immunopathologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France

bLaboratoire de Pathologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, INSERM U728, Université D. Diderot Paris VII, France

cService d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, France

dService de Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France

eLaboratoire de Virologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université D. Diderot Paris VII, Paris, France.

Received 24 April, 2009

Revised 17 July, 2009

Accepted 17 July, 2009

Correspondence to Dr Laurence Gérard, MD, Service d'Immunopathologie Clinique, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010 Paris, France. Tel: +33 1 42499177; fax: +33 1 42499256; e-mail: laurence.gerard@sls.aphp.fr

© 2009 Lippincott Williams & Wilkins, Inc.