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Ann Intern Med. 2017 Jan 3;166(1):9-17. doi: 10.7326/M16-0240. Epub 2016 Oct 18.

Chronic Hepatitis B and C Virus Infection and Risk for Non-Hodgkin Lymphoma in HIV-Infected Patients: A Cohort Study.

Author information

From Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel, Basel, Switzerland; University of Siena, Siena, Italy; University College London, London, United Kingdom; Innsbruck Medical University, Innsbruck, Austria; University of Athens, Athens, Greece; Université Bordeaux, Bordeaux, France; Stichting HIV Monitoring, Amsterdam, the Netherlands; University Hospital of Cologne, Cologne, Germany; Hospital General Universitario Gregorio Marañón, Madrid, Spain; Rigshospitalet, Copenhagen, Denmark; IRCCS Ospedale San Raffaele, Milan, Italy; National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy; University of Brescia, Brescia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Barcelona, Barcelona, Spain; Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium; and University Hospital Zurich and University of Zurich, Zurich, Switzerland.



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.


To investigate whether chronic HBV and HCV infection are associated with increased incidence of NHL in HIV-infected patients.


Cohort study.


18 of 33 cohorts from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE).


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.


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.


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.


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.


In HIV-infected patients receiving ART, chronic co-infection with HBV and HCV is associated with an increased risk for NHL.

Primary Funding Source:

European Union Seventh Framework Programme.

[Indexed for MEDLINE]

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