Brief Report: HIV-Associated Hodgkin Lymphoma Involving the Bone Marrow Identifies a Very High-Risk Subpopulation in the Era of Widescale Antiretroviral Therapy Use in Johannesburg, South Africa
| Autor: | Tracey Wiggill, Ewen D McAlpine, Yvonne Perner, Jenifer Vaughan |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Anti-HIV Agents Human immunodeficiency virus (HIV) HIV Infections 030312 virology medicine.disease_cause 03 medical and health sciences South Africa Nodular sclerosis Bone Marrow Risk Factors Internal medicine medicine Humans Pharmacology (medical) 0303 health sciences business.industry Incidence (epidemiology) medicine.disease Antiretroviral therapy Hodgkin Disease Infectious Diseases medicine.anatomical_structure Hodgkin lymphoma Female Bone marrow business Very high risk Median survival |
| Zdroj: | Journal of acquired immune deficiency syndromes (1999). 83(4) |
| ISSN: | 1944-7884 |
| Popis: | Background The incidence of HIV-associated Hodgkin lymphoma (HIV-HL) has not dropped in the era of widespread antiretroviral therapy (ART), and there have reportedly been shifts in the most prevalent variants encountered. In this study, factors of interest in cases of HIV-HL diagnosed before and after the widespread availability of ART in Johannesburg, South Africa, were compared. Methods All cases of HIV-HL diagnosed in 2007 and 2017 were extracted from the laboratory information system, and pertinent factors compared. Results The number of cases of HL increased significantly over the period assessed, but without a clear increase in the incidence of HIV-HL. As has been reported previously, the proportion of HIV-HL subclassified as the Nodular Sclerosis and Mixed Cellularity subtypes increased and decreased respectively over the period. The number of unclassifiable cases also increased significantly largely because of more frequent diagnosis in bone marrow (BM). BM involvement was highly prevalent at both timepoints (51.7% in 2007 vs 66.2% in 2017; P = 0.18), but was more frequently associated with multiple cytopenias in 2017. Despite significant ART upscaling, the median CD4 count was significantly lower in 2017 (242.5 cells/μL in 2007 vs 85.5 in 2017; P = 0.002). This particularly affected patients with BM involvement, and the median survival time was significantly shorter among BM+ patients diagnosed in 2017 as compared to those diagnosed in 2007. Notably, 40.8% of the patients with BM involvement diagnosed in 2017 died before the diagnosis was established. Conclusion HIV-HL with BM involvement identifies a very high-risk subpopulation in the post-ART era. |
| Databáze: | OpenAIRE |
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