Wednesday, October 7, 2009

HAART signicantly lowers risk of non-Hodgkin's lymphoma for up to ten years, regardless of nadir CD4 count

Antiretroviral therapy greatly reduces the incidence of non-Hodgkin’s lymphoma and its beneficial effect remains after ten years of treatment, according to the results of the largest, and longest, study into the effects of highly active antiretroviral therapy (HAART) on the incidence of this AIDS-defining cancer. The results were published in the January 11th edition of the journal, AIDS. Following the advent and widespread use of HAART in wealthier nations more than a decade ago, a decrease in the incidence of AIDS-related illnesses was observed, including that of non-Hodgkin’s lymphoma. However, previous studies of non-Hodgkin’s lymphoma incidence in the post-HAART era included relatively small numbers of people diagnosed with non-Hodgkin’s lymphoma following HAART initiation. Consequently, there are few data on the incidence of non-Hodgkin’s lymphoma in the HAART era and the effects of long-term HAART on incidence over time. Investigators for the Swiss HIV Cohort Study – which includes half of all people with HIV, and 68% of people with AIDS in Switzerland – analysed their database (which began in 1984 and included data until March 31st 2006) of 12,959 individuals, contributing a total of 75,222 person-years, of which 36,787 were spent on HAART. They identified a total of 429 non-Hodgkin’s lymphoma cases between 1984 and 2006 (365 from the Swiss HIV Cohort Study dataset and a further 64 from the Swiss Cantonal Cancer Registries). Of the approximately 3,870 cohort participants who developed AIDS during follow-up, non-Hodgkin’s lymphoma was the AIDS-defining illness for 201 (5.2%). They found that the highest incidence of non-Hodgkin’s lymphoma (13.6 per 1000) took place in the pre-HAART era (1993-1995). During the period, 2002-2006, the incidence declined to a low of 1.8 per 1000. The investigators found that individuals on HAART had a reduced risk (hazard ratio, HR) of non-Hodgkin’s lymphoma of 0.26 (95% CI, 0.20-0.33) compared with individuals not on HAART. Significant factors that increased the risk of non-Hodgkin’s lymphoma for individuals not on HAART included being male (HR versus women = 1.94; 95% CI, 1.43-2.61); being over 45 years of age (HR ≥ 45 versus < years =" 2.71;" users =" 1.81;" ratio =" 0.12">


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