NON-HODGKINS-LYMPHOMA AMONG PEOPLE WITH AIDS - INCIDENCE, PRESENTATION AND PUBLIC-HEALTH BURDEN

We describe the anatomic and histologic presentation and prognosis of non-Hodgkin's lymphoma (NHL) among people with AIDS (PWA) and determin e their contribution to the NHL burden. We linked AIDS and cancer regi stries in selected areas of the United States and compared NHL sites a nd histologies in PWA and non-PWA, after adjusting for age, sex and et hnicity. Among 51,033 PWA, we found 2,156 cases of NHL (4.3%). Half of NHL cases occurring post-AIDS were not reported to AIDS registries. N HL was part of an AIDS-defining condition for 3.2% of all PWA; the rel ative risk of NHL with 3.5 years of another AIDS diagnosis was 165-fol d compared to non-PWA within the cancer surveillance system. Of NHLs, 39% were high grade (vs. 12% among non-PWA), 60% were nodal (vs. 74% a mong non-PWA) and 15% had brain primaries (vs. 1% among non-PWA). Excl uding brain sites, extranodal sites were still 20% more common than ex pected. Relative risk was elevated for all histologic types, with the risk ranging from 652-fold for high-grade diffuse immunoblastic tumors and 261-fold for Burkitt's lymphomas to 113 for intermediate-grade ly mphoma to 14-fold for low-grade lymphoma. Survival among PWA with NHL was poor, and tumor grade had little impact. In high-risk AIDS areas, AIDS-related NHLs constitute a major share of the NHL burden. We concl ude that NHL risk is considerably under-estimated in AIDS registry dat a. The major differences between PWA and non-PWA were the high frequen cy of brain lymphoma and the increase in high-grade lymphomas in PWA. However, the grade of NHL did not influence the prognosis among PWA wi th lymphoma. The increasing risk of NHL in PWA has contributed substan tially to the general increase in NHL rates in the United States since 1981. (C) 1997 Wiley-Liss, Inc.