Longer duration of combination antiretroviral therapy reduces the risk of hodgkin lymphoma: A cohort study of HIV-infected male veterans

M. A. Kowalkowski; M. A. Mims; R. S. Day; X. L. Du; W. Chan; E. Y. Chiao

doi:10.1016/j.canep.2014.05.009

Longer duration of combination antiretroviral therapy reduces the risk of hodgkin lymphoma: A cohort study of HIV-infected male veterans

M. A. Kowalkowski, M. A. Mims, R. S. Day, X. L. Du, W. Chan, E. Y. Chiao

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

Abstract

Background: Hodgkin lymphoma (HL) incidence has increased since combined antiretroviral therapy (cART) introduction. It is unclear how different cART classes (e.g., protease inhibitors (PI), non-nucleoside reverse transcription inhibitors (NNRTI)) influence HL. This study aimed to determine the effects of cART duration on HL incidence among HIV-infected veterans. Methods: We performed a retrospective cohort study utilizing the Veterans Affairs HIV Clinical Case Registry (1985-2010). HL cases were identified using ICD-9 codes (201.4-9). cART, PI, and NNRTI duration was the aggregate number of treatment days delivered. Incidence rates (IR) and rate ratios (IRR) were calculated from Poisson regression models to examine the effects of cART duration on HL. Results: 31,576 cART users contributed 288,736 person-years (PY) and 211 HL cases (IR. = 7.3/10,000 person-years). HL incidence decreased from 25.1/10,000 PY (95%CI. = 18.9-33.4) within the first year of cART to 0.6/10,000 PY (95%CI. = 0.3-1.6) after ≥10 years. In multivariable models, each additional year of cART was associated with decreased HL incidence (IRR. = 0.80; 95%CI. = 0.75-0.86); similar effects were observed in models assessing HL incidence by PI and NNRTI. Conclusion: Our findings indicate long-term cART of any class is associated with decreased HL risk. High HL incidence directly following cART initiation supports a potential immune reconstitution mechanism in HIV-related HL. Further research is needed to evaluate the interaction between early cART, immune reconstitution, and HL.

Original language	English (US)
Pages (from-to)	386-392
Number of pages	7
Journal	Cancer Epidemiology
Volume	38
Issue number	4
DOIs	https://doi.org/10.1016/j.canep.2014.05.009
State	Published - Aug 2014
Externally published	Yes

Keywords

Combined antiretroviral therapy
Epidemiology
HIV
Hodgkin lymphoma
Non-AIDS defining cancer

ASJC Scopus subject areas

Epidemiology
Oncology
Cancer Research

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10.1016/j.canep.2014.05.009

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@article{1d147ed8a0e34e758afc32c1b3b60e93,

title = "Longer duration of combination antiretroviral therapy reduces the risk of hodgkin lymphoma: A cohort study of HIV-infected male veterans",

abstract = "Background: Hodgkin lymphoma (HL) incidence has increased since combined antiretroviral therapy (cART) introduction. It is unclear how different cART classes (e.g., protease inhibitors (PI), non-nucleoside reverse transcription inhibitors (NNRTI)) influence HL. This study aimed to determine the effects of cART duration on HL incidence among HIV-infected veterans. Methods: We performed a retrospective cohort study utilizing the Veterans Affairs HIV Clinical Case Registry (1985-2010). HL cases were identified using ICD-9 codes (201.4-9). cART, PI, and NNRTI duration was the aggregate number of treatment days delivered. Incidence rates (IR) and rate ratios (IRR) were calculated from Poisson regression models to examine the effects of cART duration on HL. Results: 31,576 cART users contributed 288,736 person-years (PY) and 211 HL cases (IR. = 7.3/10,000 person-years). HL incidence decreased from 25.1/10,000 PY (95%CI. = 18.9-33.4) within the first year of cART to 0.6/10,000 PY (95%CI. = 0.3-1.6) after ≥10 years. In multivariable models, each additional year of cART was associated with decreased HL incidence (IRR. = 0.80; 95%CI. = 0.75-0.86); similar effects were observed in models assessing HL incidence by PI and NNRTI. Conclusion: Our findings indicate long-term cART of any class is associated with decreased HL risk. High HL incidence directly following cART initiation supports a potential immune reconstitution mechanism in HIV-related HL. Further research is needed to evaluate the interaction between early cART, immune reconstitution, and HL.",

keywords = "Combined antiretroviral therapy, Epidemiology, HIV, Hodgkin lymphoma, Non-AIDS defining cancer",

author = "Kowalkowski, {M. A.} and Mims, {M. A.} and Day, {R. S.} and Du, {X. L.} and W. Chan and Chiao, {E. Y.}",

note = "Funding Information: This work was supported in part by resources and the use of facilities at the Houston Health Services Research and Development Center of Innovation (HFP90-020), Michael E. DeBakey Veterans Affairs Medical Center and the Baylor College of Medicine Dan L. Duncan Cancer Center (P30CA125123-04S1). This research was also supported by the Baylor-UTHouston Center for AIDS Research (CFAR), an NIH-funded program (AI036211). EYC ( R01CA163103 ) also received support from the NCI . The funders had no role in study design, data collection and analysis, or preparation of this report.",

year = "2014",

month = aug,

doi = "10.1016/j.canep.2014.05.009",

language = "English (US)",

volume = "38",

pages = "386--392",

journal = "Cancer Epidemiology",

issn = "1877-7821",

publisher = "Elsevier BV",

number = "4",

}

TY - JOUR

T1 - Longer duration of combination antiretroviral therapy reduces the risk of hodgkin lymphoma

T2 - A cohort study of HIV-infected male veterans

AU - Kowalkowski, M. A.

AU - Mims, M. A.

AU - Day, R. S.

AU - Du, X. L.

AU - Chan, W.

AU - Chiao, E. Y.

N1 - Funding Information: This work was supported in part by resources and the use of facilities at the Houston Health Services Research and Development Center of Innovation (HFP90-020), Michael E. DeBakey Veterans Affairs Medical Center and the Baylor College of Medicine Dan L. Duncan Cancer Center (P30CA125123-04S1). This research was also supported by the Baylor-UTHouston Center for AIDS Research (CFAR), an NIH-funded program (AI036211). EYC ( R01CA163103 ) also received support from the NCI . The funders had no role in study design, data collection and analysis, or preparation of this report.

PY - 2014/8

Y1 - 2014/8

N2 - Background: Hodgkin lymphoma (HL) incidence has increased since combined antiretroviral therapy (cART) introduction. It is unclear how different cART classes (e.g., protease inhibitors (PI), non-nucleoside reverse transcription inhibitors (NNRTI)) influence HL. This study aimed to determine the effects of cART duration on HL incidence among HIV-infected veterans. Methods: We performed a retrospective cohort study utilizing the Veterans Affairs HIV Clinical Case Registry (1985-2010). HL cases were identified using ICD-9 codes (201.4-9). cART, PI, and NNRTI duration was the aggregate number of treatment days delivered. Incidence rates (IR) and rate ratios (IRR) were calculated from Poisson regression models to examine the effects of cART duration on HL. Results: 31,576 cART users contributed 288,736 person-years (PY) and 211 HL cases (IR. = 7.3/10,000 person-years). HL incidence decreased from 25.1/10,000 PY (95%CI. = 18.9-33.4) within the first year of cART to 0.6/10,000 PY (95%CI. = 0.3-1.6) after ≥10 years. In multivariable models, each additional year of cART was associated with decreased HL incidence (IRR. = 0.80; 95%CI. = 0.75-0.86); similar effects were observed in models assessing HL incidence by PI and NNRTI. Conclusion: Our findings indicate long-term cART of any class is associated with decreased HL risk. High HL incidence directly following cART initiation supports a potential immune reconstitution mechanism in HIV-related HL. Further research is needed to evaluate the interaction between early cART, immune reconstitution, and HL.

AB - Background: Hodgkin lymphoma (HL) incidence has increased since combined antiretroviral therapy (cART) introduction. It is unclear how different cART classes (e.g., protease inhibitors (PI), non-nucleoside reverse transcription inhibitors (NNRTI)) influence HL. This study aimed to determine the effects of cART duration on HL incidence among HIV-infected veterans. Methods: We performed a retrospective cohort study utilizing the Veterans Affairs HIV Clinical Case Registry (1985-2010). HL cases were identified using ICD-9 codes (201.4-9). cART, PI, and NNRTI duration was the aggregate number of treatment days delivered. Incidence rates (IR) and rate ratios (IRR) were calculated from Poisson regression models to examine the effects of cART duration on HL. Results: 31,576 cART users contributed 288,736 person-years (PY) and 211 HL cases (IR. = 7.3/10,000 person-years). HL incidence decreased from 25.1/10,000 PY (95%CI. = 18.9-33.4) within the first year of cART to 0.6/10,000 PY (95%CI. = 0.3-1.6) after ≥10 years. In multivariable models, each additional year of cART was associated with decreased HL incidence (IRR. = 0.80; 95%CI. = 0.75-0.86); similar effects were observed in models assessing HL incidence by PI and NNRTI. Conclusion: Our findings indicate long-term cART of any class is associated with decreased HL risk. High HL incidence directly following cART initiation supports a potential immune reconstitution mechanism in HIV-related HL. Further research is needed to evaluate the interaction between early cART, immune reconstitution, and HL.

KW - Combined antiretroviral therapy

KW - Epidemiology

KW - HIV

KW - Hodgkin lymphoma

KW - Non-AIDS defining cancer

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JF - Cancer Epidemiology

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ER -

Longer duration of combination antiretroviral therapy reduces the risk of hodgkin lymphoma: A cohort study of HIV-infected male veterans

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