Early development of non-hodgkin lymphoma following initiation of newer class antiretroviral therapy among HIV-infected patients - implications for immune reconstitution.docVIP

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Early development of non-hodgkin lymphoma following initiation of newer class antiretroviral therapy among HIV-infected patients - implications for immune reconstitution.doc

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Early development of non-hodgkin lymphoma following initiation of newer class antiretroviral therapy among HIV-infected patients - implications for immune reconstitution

Huhnetal.AIDSResearchandTherapy2010,7:44 /content/7/1/44 SHORT REPORT OpenAccess Earlydevelopmentofnon-hodgkinlymphoma followinginitiationofnewerclassantiretroviral therapyamongHIV-infectedpatients-implications forimmunereconstitution GregoryDHuhn1,2*,SheilaBadri1,2,SoniaVibhakar3,4,FrankTverdek2,ChristopherCrank2,RonaldLubelchek1,2, BlakeMax3,4,DavidSimon2,BeverlySha2,OluwatoyinAdeyemi1,2,PatriciaHerrera1,2,AllanTenorio2,HaroldKessler2, DavidBarker1,2 Abstract Background:IntheHAARTera,theincidenceofHIV-associatednon-Hodgkinlymphoma(NHL)isdecreasing.We describecasesofNHLamongpatientswithmulti-classantiretroviralresistancediagnosedrapidlyafterinitiating newer-classantiretrovirals,andexaminetheimmunologicandvirologicfactorsassociatedwithpotentialIRIS- mediatedNHL. Methods:DuringDecember2006toJanuary2008,eligibleHIV-infectedpatientsfromtwoaffiliatedclinicsaccessed ExpandedAccessProgramantiretroviralsofraltegravir,etravirine,and/ormaravirocwithoptimizedbackground.A NHLcasewasdefinedasapathologically-confirmedtissuediagnosisinapatientwithoutpriorNHLdeveloping symptomsafterstartingnewer-classantiretrovirals.MeanchangeinCD4andlog10 VLinNHLcasescomparedto controlswasanalyzedatweek12,atimepointatwhichvalueswerecollectedamongallcases. Results:Fivecasesoccurredamong78patients(meanincidence=64.1/1000patient-years).Allcasesreceived raltegravirandonereceivedetravirine.Mediansymptomonsetfromnewer-classantiretroviralinitiationwas 5weeks.Atbaseline,themedianCD4andVLforNHLcases(n=5)versuscontrols(n=73)were44vs.117cells/ mm3(p=0.09)and5.2vs.4.2log10 (p=0.06),respectively.ThemeanincreaseinCD4atweek12inNHLcases comparedtocontrolswas13(n=5)vs.74(n=50)(p=0.284).MeanVLlog10 reductioninNHLcasesversus controlsatweek12was2.79(n=5)vs.1.94(n=50)(p=0.045). Conclusions:AnunexpectedlyhighrateofNHLwasdetectedamongtreatment-experiencedpatientsachievinga highlevelofvirologicresponsewithnewer-classantiretrovirals.WeobservedtrendstowardlowerbaselineCD4 andhigherbaselineVLinNHLcases,