Patients with HIV who receive antiretroviral therapy have higher risk for non-Hodgkin’s lymphoma if they are coinfected with hepatitis B and C viruses, according to study findings published in Annals of Internal Medicine.
“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,” Qing Wang, PhD, of University Hospital Basel in Switzerland, and colleagues wrote. “[However], the role of chronic coinfection with HBV and HCV in promoting non-Hodgkin’s lymphoma in HIV infection is unclear.”
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 coinfection 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 coinfection and 0.67 (95% CI, 0.4-1.12) for those with HCV coinfection. 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.” – by Alaina Tedesco
Disclosure: Wang does not report any relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.