Prognosis of HIV-associated non-Hodgin lymphoma in patients starting combination antiretroviral therapy: European multi-cohort study

Objective: We examined survival and prognostic factors of patients who developed HIVassociated non-Hodgkin lymphoma (NHL) in the era of combination antiretroviral therapy (cART). Design and setting: Multi-cohort collaboration of 33 European cohorts. Methods: We included all cART naïve patients enrolled in cohorts participating in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who were aged 16 years or older, started cART at some point after 1 January 1998 and developed NHL after 1 January 1998. Patients had to have a CD4 cell count after 1 January 1998 and one at diagnosis of the NHL. Survival and prognostic factors were estimated using Weibull models, with random-effects accounting for heterogeneity between cohorts. Results: Of 67,659 patients who were followed up during 304,940 person-years, 1,176 patients were diagnosed with NHL. Eight-hundred and forty-seven patients (72%) from 22 cohorts met inclusion criteria. Survival at one year was 66% (95% confidence interval [CI] 63-70%) for systemic NHL (n=763) and 54% (95% CI 43%-65%) for primary brain lymphoma (PBL, n=84). Risk factors for death included low nadir CD4 cell counts and a history of injection drug use. Patients developing NHL on cART had an increased risk of death compared to patients who were cART naïve at diagnosis. Conclusions: In the era of cART two thirds of patients diagnosed with HIV-related systemic NHL survive for longer than one year after diagnosis. Survival is poorer in patients diagnosed with PBL. More advanced immunodeficiency is the dominant prognostic factor for mortality in patients with HIV-related NHL.