Anti-retroviral treatment regimens and immune parameters in the prevention of systemic HIV-related non-Hodgkin's lymphoma

Abstract

1034 Background: Immunosuppression induced by the human immunodeficiency virus (HIV) leads to an increased risk of non Hodgkin's lymphoma (NHL). We measured the influence of immunological factors and highly active antiretroviral therapy (HAART) regimes on this risk. As there are few data demonstrating that non nucleoside reverse transcriptase inhibitors (NNRTI) can protect from AIDS-defining illnesses, we compared different HAART regimens. Methods: The protective effect of HAART regimens, containing protease inhibitors (PI) and/or NNRTIs on the development of NHL was examined in a prospectively recorded cohort of 9,621 HIV-infected individuals. Lymphocyte and natural killer subset data were also examined and entered in a univariate and multivariate analysis to establish risk of NHL. Results: 280 patients have been diagnosed with lymphoma including 206 with systemic NHL, 55 with primary cerebral lymphoma and 19 with Hodgkin's disease. During the HAART era (1996–2003), 5,832 individuals have been identified as being at risk of systemic NHL, representing a total of 34,133 patient years of follow up. Of these, 102 patients have been diagnosed with systemic HIV-related NHL. Univariate analysis demonstrated that increased age, higher nadir CD4 and CD8 T cell counts, CD19 B cell count, CD16/56 natural killer count and exposure to NNRTI or PI containing HAART conferred significant protection against NHL (p<0.05). In a multivariate analysis, age, nadir CD4 and CD8 T cell counts and exposure to HAART were independent predictors of risk of NHL (p < 0.02). NNRTI based HAART (adjusted rate ratio 0.4, 95% CI 0.3 to 0.5) had an identical protective effect to PI-based HAART and these were significantly more protective than nucleoside analogues alone (rate ratio 0.5, 95% CI 0.4 to 0.7) or no anti-retrovirals (p<0.001). Conclusions: HAART induced maintenance of CD4 and CD8 counts protects from systemic AIDS-related NHL. No significant financial relationships to disclose.