Prognostic factors after non-Hodgkin lymphoma in patients infected with the human immunodeficiency virus - Aquitaine Cohort, France, 1986-1997

BAGKGROUND. The prognosis for survival of patients infected with the human immunodeficiency virus (HIV) who develop non-Hodgkin lymphoma (NHL) usually is considered to be poor. To the authors' knowledge the impact of highly a ctive antiretroviral therapy, recently introduced in HIV disease case manag ement, has not yet been studied in such circumstances. METHODS. All cases of NHL prospectively diagnosed between January 1986 and December 1997 among patients followed in the Aquitaine Cohort were reviewed . The Kaplan-Meier method and the proportional hazards model were used for statistical analysis. RESULTS. One hundred one NHL diagnoses were validated during the 12-year st udy period. The median proportional hazards cell count at the time of diagn osis of NHL was 112/mm(3). Histologic findings (Working Formulation classif ication) were: intermediate grade (N = 23), high grade (N = 61), other (N = 7), and undetermined (N = 10). In 56% of cases, staging classification was Ann Arbor Stage N. Approximately 73% of patients received a specific NHL c hemotherapy. During follow-up, 44% were treated with nucleoside reverse tra nscriptase inhibitors (NR TIs) alone and 18% with triple therapy including a protease inhibitor (PI). The median survival was 6.0 months. In multivari ate analysis, after adjusting for age, year of NHL diagnosis, histologic ty pe, medical center, and transmission category, the following factors record ed at the time of diagnosis of NHL were indicative of an increasing risk of death: CD4+ count less than or equal to 50/mm(3) (relative hazard [RH: 2.4 , 95% confidence interval [95% CI], 1.2-4.7), hemoglobin less than or equal to 10 g/dL. (RH: 2.1, 95% CI, 1.1-4.0), and Ann Arbor Stage TV (RH: 2.0, 9 5% CI, 1.2-3.6). Antiretroviral therapy after the diagnosis of NHL was asso ciated with survival: NRTIs (RH: 0.27, 95% CI, 0.13-0.53) and NRTIs plus PI (RH: 0.08, 95% CI, 0.03-0.21). CONCLUSIONS. Although recently introduced and prescribed, antiretroviral th erapy including PIs already has improved the survival of HIV-infected patie nts with NHL significantly. (C) 2000 American Cancer Society.