Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

Following the introduction of potent antiretroviral therapy in the mid-1990s, the incidence of non-Hodgkin lymphoma (NHL) did not appear to drop as dramatically as other AIDS diseases. We aimed to investigate whether the risk of NHL has changed more recently, and to assess the importance of current and nadir CD4 cell count and other prognostic factors in predicting an NHL diagnosis, thus determining whether early initiation of therapy may be warranted in certain groups. We used Cox models for the time from seroconversion (SC) to an NHL diagnosis, stratifying by cohort and allowing for late entry, in a pooled dataset of 20 seroconverter cohorts in Europe and Australia (CASCADE). We considered changes in the risk of NHL over three periods (to 1996, 1997-1998, 1999-2001), adjusting for age at SC; exposure category; and sex. The prognostic roles of these co-factors, and of (time-dependent) current and nadir CD4 count, were then further investigated. Poisson regression was used to estimate absolute incidence rates of NHL. Of 6476 seroconverters included in the analysis, 82 were diagnosed with NHL. Compared to pre-1997, there was little reduction in the risk of NHL in 1997-98 (RR = 0.7, 95% CI 0.4-1.2). However, by 1999-2001, the risk had fallen substantially (RR = 0.2, 95% CI 0.1-0.6). Compared to individuals with most recent CD4 ³350 cells/mm³, the relative risk (95% CI) of NHL increased to 1.9 (0.9-4.0), 1.5 (0.5-4.5) and 14.0 (6.4-30.9) for those with CD4 200-349, 100-199, and 0-99 cells/mm³ respectively. There was no evidence that nadir CD4 cell count added additional information to predicting the risk of NHL (p = 0.62). Gay men appeared to be at slightly higher risk than those infected through injecting drug use and sex between men and women (RR 1.8, 95% CI 0.9- 3.8, p = 0.07), and the absolute incidence rate (95% CI) in gay men in the pre- 1997 period was estimated to be 1.7 (1.0-2.9) cases per 1000 person-years at CD4 ³350 cells/mm³, compared with 3.1 (1.7-5.6), 2.4 (0.9-6.5), and 24.9 (17.0-36.7) cases per 1000 person-years at CD4 counts of 200-349, 100-199, and 0-99 cells/mm³ respectively. In conclusion, early initiation of HAART because of concerns over the risk of NHL once CD4 count has fallen below 350 do not appear to be justified in any risk group.

Presenting author: Krishnan Bhaskaran

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2002-11-17
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