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Association of early HIV viremia with mortality after HIV-associated lymphoma

Gopal, Satisha,*; Patel, Monita R.a,*; Yanik, Elizabeth L.a; Cole, Stephen R.a; Achenbach, Chad J.b; Napravnik, Soniaa; Burkholder, Greer A.c; Reid, Erin G.d; Rodriguez, Benignoe; Deeks, Steven G.f; Mayer, Kenneth H.g; Moore, Richard D.h; Kitahata, Mari M.i; Richards, Kristy L.a; Eron, Joseph J.a

doi: 10.1097/QAD.0b013e3283635232
Clinical Science

Objective: To examine the association between early HIV viremia and mortality after HIV-associated lymphoma.

Design: Multicenter observational cohort study.

Setting: Center for AIDS Research Network of Integrated Clinical Systems cohort.

Participants: HIV-infected patients with lymphoma diagnosed between 1996 and 2011, who were alive 6 months after lymphoma diagnosis and with at least two HIV RNA values during the 6 months after lymphoma diagnosis.

Exposure: Cumulative HIV viremia during the 6 months after lymphoma diagnosis, expressed as viremia copy-6-months.

Main outcome measure: All-cause mortality between 6 months and 5 years after lymphoma diagnosis.

Results: Of 224 included patients, 183 (82%) had non-Hodgkin lymphoma (NHL) and 41 (18%) had Hodgkin lymphoma. At lymphoma diagnosis, 105 (47%) patients were on antiretroviral therapy (ART), median CD4+ cell count was 148 cells/μl (interquartile range 54–322), and 33% had suppressed HIV RNA (<400 copies/ml). In adjusted analyses, mortality was associated with older age [adjusted hazard ratio (AHR) 1.37 per decade increase, 95% CI 1.03–1.83], lymphoma occurrence on ART (AHR 1.63, 95% CI 1.02–2.63), lower CD4+ cell count (AHR 0.75 per 100 cells/μl increase, 95% CI 0.64–0.89), and higher early cumulative viremia (AHR 1.35 per log10copies × 6-months/ml, 95% CI 1.11–1.65). The detrimental effect of early cumulative viremia was consistent across patient groups defined by ART status, CD4+ cell count, and histology.

Conclusion: Exposure to each additional 1-unit log10 in HIV RNA throughout the 6 months after lymphoma diagnosis was associated with a 35% increase in subsequent mortality. These results suggest that early and effective ART during chemotherapy may improve survival.

aUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina

bNorthwestern University, Chicago, Illinois

cUniversity of Alabama at Birmingham, Birmingham, Alabama

dUniversity of California at San Diego, San Diego, California

eCase Western Reserve University, Cleveland, Ohio

fUniversity of California at San Francisco, San Francisco, California

gFenway Health, Boston, Massachusetts

hJohns Hopkins University, Baltimore, Maryland

iUniversity of Washington, Seattle, Washington, USA.

*Satish Gopal and Monita R. Patel contributed equally to the writing of the study.

Correspondence to Satish Gopal, MD, MPH, Program in Global Oncology, Lineberger Comprehensive Cancer Center, UNC Project-Malawi, Tidziwe Center, Private Bag A-104, Lilongwe, Malawi. Tel: +265 1 755 056; fax: +265 1 755 954; e-mail:

Received 4 April, 2013

Revised 9 May, 2013

Accepted 9 May, 2013

© 2013 Lippincott Williams & Wilkins, Inc.