Non-Hodgkin’s lymphoma risk higher for co-infected patients

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Patients with HIV who receive antiretroviral therapy have higher risk for non-Hodgkin’s lymphoma if they are co-infected with hepatitis B and C viruses, according to study findings.

“In the HIV-negative population, growing evidence suggests that chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are both associated with non-Hodgkin’s lymphoma,” Dr Qing Wang, of University Hospital Basel in Switzerland, and colleagues wrote. “(However), the role of chronic co-infection with HBV and HCV in promoting non-Hodgkin’s lymphoma in HIV infection is unclear.”

Healio reports that Wang and colleagues collected data from 18 of 33 cohort studies that were included in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) to assess the influence of chronic HBV and HCV co-infection on the occurrence of non-Hodgkin’s lymphoma in patients with HIV. Participants were assessed during two phases: when they were treatment-naive and after starting antiretroviral therapy (ART) if they opted to initiate treatment. The researchers used time-dependent Cox models to determine the incidence of non-Hodgkin’s lymphoma in patients during both periods.

The study included 52,479 treatment-naïve patients. Of those, 40,219 (77%) patients initiated ART at a later date. A total of 1,339 (2.6%) patients had chronic HBV infection and 7,506 (14.3%) had chronic HCV infection. Treatment-naive patients and patients who initiated ART had a median follow-up of 13 months and 50 months, respectively. Among treatment-naive patients, 252 developed non-Hodgkin’s lymphoma (incidence rate, 219 cases per 100,000 person-years), compared with 310 patients who received treatment (incidence rate, 168 cases per 100,000 person-years).

The hazard ratios for non-Hodgkin’s lymphoma were 1.33 (95% CI, 0.69-2.56) for treatment-naive patients with HBV co-infection and 0.67 (95% CI, 0.4-1.12) for those with HCV co-infection. In addition, among patients treated with ART, those with HBV and HCV infection had hazard ratios of 1.74 (CI, 1.08 to 2.82) and 1.73 (CI, 1.21 to 2.46), respectively, for non-Hodgkin’s lymphoma.

“Our study was not sufficiently powered to show such an association in ART-naive co-infected patients,” Wang and colleagues concluded. “Early diagnosis and treatment of HIV infection in conjunction with routine screening for chronic HBV and HCV infection is essential to further decrease non-Hodgkin’s lymphoma morbidity and mortality in HIV-infected persons.”

Abstract
Background: Non-Hodgkin lymphoma (NHL) is the most common AIDS-defining condition in the era of antiretroviral therapy (ART). Whether chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection promote NHL in HIV-infected patients is unclear.
Objective: To investigate whether chronic HBV and HCV infection are associated with increased incidence of NHL in HIV-infected patients.
Design: Cohort study.
Setting: 18 of 33 cohorts from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE).
Patients: HIV-infected patients with information on HBV surface antigen measurements and detectable HCV RNA, or a positive HCV antibody test result if HCV RNA measurements were not available.
Measurements: Time-dependent Cox models to assess risk for NHL in treatment-naive patients and those initiating ART, with inverse probability weighting to control for informative censoring.
Results: A total of 52 479 treatment-naive patients (1339 [2.6%] with chronic HBV infection and 7506 [14.3%] with HCV infection) were included, of whom 40 219 (77%) later started ART. The median follow-up was 13 months for treatment-naive patients and 50 months for those receiving ART. A total of 252 treatment-naive patients and 310 treated patients developed NHL, with incidence rates of 219 and 168 cases per 100 000 person-years, respectively. The hazard ratios for NHL with HBV and HCV infection were 1.33 (95% CI, 0.69 to 2.56) and 0.67 (CI, 0.40 to 1.12), respectively, in treatment-naive patients and 1.74 (CI, 1.08 to 2.82) and 1.73 (CI, 1.21 to 2.46), respectively, in treated patients.
Limitation: Many treatment-naive patients later initiated ART, which limited the study of the associations of chronic HBV and HCV infection with NHL in this patient group.
Conclusion: In HIV-infected patients receiving ART, chronic co-infection with HBV and HCV is associated with an increased risk for NHL.

Authors
Qing Wang; Andrea De Luca; Colette Smith; Robert Zangerle; Helen Sambatakou; Fabrice Bonnet; Colette Smit; Philipp Schommers; Alicia Thornton; Juan Berenguer; Lars Peters; Vincenzo Spagnuolo; Adriana Ammassari; Andrea Antinori; Eugenia Quiros Roldan; Cristina Mussini; Jose M Miro; Deborah Konopnicki; Jan Fehr; Maria A Campbell; Monique Termote; Heiner C Bucher

Healio material
Annals of Internal Medicine abstract


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