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Clin Infect Dis. 2014 Jul 15;59(2):279-86. doi: 10.1093/cid/ciu270. Epub 2014 Apr 21.

Lymphoma immune reconstitution inflammatory syndrome in the center for AIDS research network of integrated clinical systems cohort.

Author information

1
University of North Carolina at Chapel Hill.
2
Northwestern University, Chicago, Illinois.
3
University of Alabama at Birmingham.
4
University of California, San Diego.
5
Case Western Reserve University, Cleveland, Ohio.
6
University of California, San Francisco.
7
Fenway Health, Boston, Massachusetts.
8
Johns Hopkins University, Baltimore, Maryland.
9
University of Washington, Seattle.

Abstract

BACKGROUND:

Lymphoma incidence is increased among human immunodeficiency virus (HIV)-infected individuals soon after antiretroviral therapy (ART), perhaps due to unmasking immune reconstitution inflammatory syndrome (IRIS). Clinical characteristics and survival for unmasking lymphoma IRIS have not been described.

METHODS:

We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) from 1996 until 2011. Unmasking lymphoma IRIS was defined as lymphoma within 6 months after ART accompanied by a ≥ 0.5 log10 copies/mL HIV RNA reduction. Differences in presentation and survival were examined between IRIS and non-IRIS cases.

RESULTS:

Of 482 lymphoma patients, 56 (12%) met criteria for unmasking lymphoma IRIS. Of these, 12 (21%) had Hodgkin lymphoma, 22 (39%) diffuse large B-cell lymphoma, 5 (9%) Burkitt lymphoma, 10 (18%) primary central nervous system lymphoma, and 7 (13%) other non-Hodgkin lymphoma. Median CD4 cell count at lymphoma diagnosis among IRIS cases was 173 cells/µL (interquartile range, 73-302), and 48% had suppressed HIV RNA <400 copies/mL. IRIS cases were similar overall to non-IRIS cases in histologic distribution and clinical characteristics, excepting more frequent hepatitis B and C (30% vs 19%, P = .05), and lower HIV RNA at lymphoma diagnosis resulting from the IRIS case definition. Overall survival at 5 years was similar between IRIS (49%; 95% confidence interval [CI], 37%-64%) and non-IRIS (44%; 95% CI, 39%-50%), although increased early mortality was suggested among IRIS cases.

CONCLUSIONS:

In a large HIV-associated lymphoma cohort, 12% of patients met a uniformly applied unmasking lymphoma IRIS case definition. Detailed studies of lymphoma IRIS might identify immunologic mechanisms of lymphoma control.

KEYWORDS:

HIV/AIDS; Hodgkin lymphoma; immune reconstitution inflammatory syndrome; lymphoma; non-Hodgkin lymphoma

PMID:
24755860
PMCID:
PMC4102912
DOI:
10.1093/cid/ciu270
[Indexed for MEDLINE]
Free PMC Article

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