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US study shows importance of access to chemotherapy for HIV-positive patients with Hodgkin lymphoma
Michael Carter, 2016-01-28 07:20:00
HIV is associated
with poorer outcomes in patients diagnosed with Hodgkin lymphoma, according to
US research published in AIDS.
Analysis of the National Cancer Data Base revealed a 66% five-year survival
rate for patients with HIV compared to 80% for the general population.
poorer survival rate associated with HIV was driven mainly by lower rates of
chemotherapy administration, which in turn was associated with high rates of
poverty and markers of social exclusion. However, HIV-positive patients with
classic presentation of Hodgkin lymphoma who received chemotherapy had survival
rates comparable to those observed in the HIV-negative population.
“We found that a
significant proportion (18%) of HIV-infected Hodgkin lymphoma patients do not
receive treatment for this curable cancer, which is 1.7 times higher than in
the HIV-negative population,” comment the authors. “Nonreceipt of chemotherapy
correlated with unfavourable socioeconomic variables, including black race,
lack of health insurance and residence in high-poverty areas.”
Hodgkin lymphoma is a cancer of the lymph nodes and lymphatic system. Incidence of
Hodgkin lymphoma among people with HIV is up to 20 times higher than that seen
in the general population. The cancer can be treated successfully in most people, especially if diagnosed early. Findings from observational cohort studies suggest
that HIV-positive patients can have comparable disease outcomes to HIV-negative
individuals, provided they receive antiretroviral therapy and appropriate
cancer treatment. In contrast, population-based research has consistently shown
that patients with HIV have poorer overall survival, with a five-year estimate
of approximately 63%.
essential for the curative treatment of classic presentations of Hodgkin
lymphoma. A team of investigators therefore hypothesised that the poor survival
rates observed in HIV-positive patients enrolled in population-based studies
could be due to suboptimal delivery of chemotherapy. To test this theory, they studied
information from the National Cancer Data Base to evaluate management patterns
and survival trends in Hodgkin lymphoma patients according to HIV infection
Cancer Data Base covers at least 70% of cancer diagnoses in the US. The investigators
extracted the records of patients who were diagnosed with Hodgkin lymphoma
between 2004 and 2012. Information was available on the HIV status of each patient.
For those with HIV, details of CD4 cell count and use of antiretroviral therapy
classified according to race and ethnicity. Lymphoma was staged as favourable,
unfavourable, or advanced. Household income and area of residence were used as
markers of socioeconomic status, and data were also gathered on type of
treatment centre and health insurance status.
A total of 43,935
Hodgkin lymphoma patients were recorded during the study period and 5% (2090)
were HIV positive.
patients in the general population, patients with HIV were older, more likely
to be male and a significantly higher proportion were Hispanic or Black. The majority
of HIV-positive individuals lived in urban areas, had a low household income
and had Medicaid health insurance, consistent with their low income and
patients with HIV had advanced Hodgkin lymphoma. HIV-positive Hodgkin lymphoma
was more likely to be extranodal, the most frequent sites being bone marrow
(46% of extranodal cases), gastrointestinal tract (28%) and head and neck
was the most common subtype in both HIV-positive and HIV-negative patients. Patients
with HIV were more likely to have undetermined histologic types (40% vs. 26%).
In terms of
treatment, 81% of patients with HIV received chemotherapy (12% in combination
with radiotherapy), 13% received any radiotherapy and 16% had no therapy.
Treatment rates were significantly lower than those seen in the HIV-negative
population (87%, 31%, 9%, respectively; all p < 0.00001).
Early stage disease
was less likely to be treated in patients with HIV than in HIV-negative
individuals (28% vs. 41%).
with HIV-positive people not receiving chemotherapy were older age, male sex, insurance
type, living in low income areas, early stage disease and undetermined disease
followed for a median of 51 months. The overall five-year survival for patients
with HIV was 66%, significantly lower than the 80% observed in HIV-negative
patients. HIV-positive patients also had poorer survival when outcomes were
stratified according to Hodgkin lymphoma disease stage.
key to improved survival in patients with HIV.
For patients with
classic Hodgkin lymphoma who received chemotherapy, there was no significant
difference in the risk of death between HIV-positive and HIV-negative
HIV-positive patients treated with chemotherapy showed that poorer survival was
associated with advancing age, underdetermined histological type and insurance
“The fact that
survival with active treatment is not influenced by HIV status in patients with
classical subtypes of Hodgkin lymphoma underscores the need for an aggressive
approach,” conclude the authors. “Patients with undetermined histology require
particular attention due to worse prognosis and high risk of nontreatment.”