Featured news from NHIVNA
HIV-related news from NAM
Good outcomes for people living with HIV diagnosed with Hodgkin's lymphoma in France
Michael Carter, 2015-08-26 08:20:00
People living with HIV who are diagnosed with Hodgkin’s lymphoma now have excellent outcomes, French
investigators report in the online edition of Clinical Infectious Diseases. Two-year overall and progression-free
survival rates were 94% and 89%, respectively, outcomes which are at least as good
as those seen in HIV-negative individuals.
“We confirm, in
the setting of an observational cohort prospective study, the striking
improvement in the prognosis of…[Hodgkin’s] lymphomas in the modern cART
[combination antiretroviral therapy] era,” comment the investigators. “When
comparing the prognosis of HIV-infected patients with a prospective series of
HIV-negative patients recruited in France during the same period, we did not
see any difference in outcome.”
Infection with HIV
has been associated with an increased risk of lymphomas. Although incidence of
non-Hodgkin’s lymphoma has declined since the introduction of effective
antiretroviral therapy, rates of Hodgkin’s lymphoma have remained stable. Indeed,
it’s been estimated that incidence of Hodgkin’s lymphoma is 19-times higher in
patients with HIV compared to their HIV-negative peers. Moreover, there is
concern that new diagnoses of this type of cancer will increase as the population of people living with HIV ages.
HIV infection had
been associated with poorer outcomes in patients with Hodgkin’s lymphoma. But
recent studies conducted in Britain and Germany have shown that survival rates
among patients living with HIV with Hodgkin’s lymphoma are now approaching those
seen in HIV-uninfected individuals.
the French LYMPHOVIR cohort wanted to establish a clearer understanding of rates
of the overall and progression-free survival rates among people who have HIV and Hodgkin’s
lymphoma in the modern antiretroviral treatment era. They therefore
designed a prospective study involving 68 patients who have HIV who were newly
diagnosed with Hodgkin’s lymphoma between 2008 and 2014. As well as determining
two-year survival rates, the authors also analysed the factors associated with
survival and compared the characteristics and outcomes of patients who have HIV with 336 HIV-negative patients diagnosed with this cancer at approximately the
The patients who have HIV had a median age of 44 years and 87% were male. Median CD4 count at
the time of cancer diagnosis was 387 cells/mm3. Most (94%) individuals
were taking HIV therapy when Hodgkin’s lymphoma was detected. All patients
received antiretrovirals when under cancer therapy.
with poorer disease outcomes were prevalent: 93% of tested individuals had EBV present
in tumour tissue and 76% had advanced disease (Ann-Arbor stages III-IV).
In terms of cancer
therapy, patients with less advanced disease (stages I-II) were treated with
three to four cycles of ABVD followed by radiotherapy. The majority of
individuals with advanced stage III-IV disease received an ABVD/ABVD-like
regimen. Two individuals were treated with BEACOPP. The most common side
effects were neuropathy (n = 7), sepsis (n = 7), pulmonary toxicity (n = 4) and
cardiac failure (n = 1).
was for 38 months. Five patients died, two due to early progression, two
following relapse and one from sepsis.
and progression-free survival rates were 94% and 89%, respectively.
The low number of
clinical events meant that analysis of prognostic factors was limited to
progression free survival. The only factor associated with disease progression
or death was age over 45 years (OR = 8.1; 95% CI, 1.0-67.0).
were treated with the combination of cART and ABVD which have been found to
offer very good outcomes with limited toxicity,” write the authors. “Therefore,
our data are in line with the recently published recommendations concluding
that ABVD should be the treatment of choice in patients with
survival rates over two years were comparable between the people living with HIV and
HIV-negative patients (89% vs. 86%, respectively). This was despite the
HIV-positive patients having a higher prevalence of risk factors – demographic, pathological, clinical and
biological – associated with poor outcomes.
“The outcomes of
Hodgkin’s lymphoma in HIV-infected patients in the recent cART era do not
differ from those of non HIV-infected patients,” conclude the investigators.”