Published online 31 March 2009
Haematologica, Vol 94, Issue 6, 875-880 doi:10.3324/haematol.2008.002691
Copyright © 2009 by Ferrata Storti Foundation
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Brief Reports

CD4 counts and the risk of systemic non-Hodgkin’s lymphoma in individuals with HIV in the UK

Mark Bower1, Martin Fisher2, Teresa Hill3, Iain Reeves2, John Walsh4, Chloe Orkin2, Andrew N. Phillips3, Loveleen Bansi3, Richard Gilson3, Philippa Easterbrook6, Margaret Johnson7, Brian Gazzard1, Clifford Leen8, Deenan Pillay9, Achim Schwenk10, Jane Anderson11, Kholoud Porter12, Mark Gompels13, Caroline A. Sabin3, for the UK CHIC Steering Committee

1 Chelsea and Westminster Hospital, London
2 Brighton and Sussex University Hospital NHS Trust
3 UCL Medical School, London
4 St. Mary’s NHS Trust, London
5 St. Bartholomews and the Royal London Hospitals
6 Kings College London School of Medicine at Guy’s, Kings College and St. Thomas’ Hospitals, London
7 Royal Free NHS Trust, London
8 Western General Hospital, Edinburgh
9 University College London
10 North Middlesex University Hospital NHS Trust
11 Homerton University Hospital NHS Foundation Trust, London
12 Medical Research Council Clinical Trials Unit, London
13 North Bristol NHS Trust, Bristol, UK

Correspondence: Professor Caroline A. Sabin, Research Department of Infection and Population Health, Division of Population Health, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK. E-mail:c.sabin{at}pcps.ucl.ac.uk

ABSTRACT

Since the introduction of highly active antiretroviral therapy, there has been a decline in the incidence of non-Hodgkin’s lymphoma among HIV-infected individuals. We described trends in the incidence of systemic non-Hodgkin’s lymphoma in the UK CHIC Study from 1996–2006 and evaluated the association between immunosuppression and development of systemic non-Hodgkin’s lymphoma: 286/23,155 (1.2%) individuals developed an AIDS-defining lymphoma (258 systemic). Younger age, receipt of highly active antiretroviral therapy and later calendar year were all independently associated with a reduced risk of systemic non-Hodgkin’s lymphoma. A lower latest CD4 count was strongly associated with systemic non-Hodgkin’s lymphoma, in patients who had (RR per log2(cells/mm3) higher: 0.62) and had not (0.70) received highly active antiretroviral therapy. Associations with other measures of immunosuppression, including nadir CD4 count, experience and duration of severe immunosuppression, were generally weaker. Earlier highly active anti-retroviral therapy initiation and wider access to HIV testing is advocated to reduce the risk of systemic non-Hodgkin’s lymphoma.

Key words: non-Hodgkin’s lymphoma, HIV, immunosuppression, CD4 count, cohort study.