Strong impact of highly active antiretroviral therapy on survival in patients with human immunodeficiency virus‐associated Hodgkin's disease

Abstract

Summary Hodgkin's disease (HD) is the most common non‐acquired immunodeficiency syndrome (AIDS)‐defining malignancy in human immunodeficiency virus (HIV)‐infected patients. We analysed the outcome of patients with HIV‐associated HD (HIV‐HD) with respect to the use and efficacy of highly active antiretroviral therapy (HAART) and other prognostic factors. To evaluate the effects of several variables on overall survival (OS), Kaplan–Meier statistics and extended Cox regression analysis were performed. Response to HAART was used as a time‐dependent variable and was defined as an increase of >0·1 × 109 CD4 cells/l and/or at least one viral load <500 copies/ml during the first 2 years following diagnosis of HIV‐HD. Fifty‐seven patients with HIV‐HD diagnosed between 1990 and 2002 were included in the study. In the Cox model, the only factors independently associated with OS were HAART response [relative hazard (RH) 0·19; 95% confidence interval (CI) 0·06–0·60], complete remission (RH 0·30, 95% CI 0·13–0·72), and age 45 years (RH 0·23; 95% CI 0·09–0·60). Median survival time in patients without HAART response was 18·6 months, whereas the median survival time in patients with HAART response was not reached (89% OS at 24 months). In this cohort, a significant improvement in survival was found in patients with HIV‐HD who responded to HAART.

Ten‐year survival among HIV‐1‐infected subjects with AIDS or non‐AIDS‐defining malignancies

“…This may be explained by numerous HAART-related factors: the dramatic reduction in mortality due to OI and severe immune suppression, 1-4 the direct effect of some antiretroviral drugs (protease inhibitors) against specific type of cancer (KS), 23 the synergistic effect of HAART and chemotherapy on the survival of patients with NHL, KS and HD, [15][16][17]24 the improved performance status that allowed a more aggressive approach against cancer in HIV-infected subjects and the marked decrease in the incidence of specific malignancies characterized by a poorer prognosis (e.g., visceral KS and primary brain NHL). [25][26][27][28] In our study, survival rates in the ADM and NADM groups were similar in the two eras, a finding that is in line with those of Long et al 29 who investigated cancer survival during the post-HAART era, in a large urban cohort of HIVinfected subjects.…”

“…10 These findings may be attributable both to specific cancer characteristics in HIV-infected individuals (a more aggressive behavior and an advanced stage at diagnosis) [6][7][8]11,12 and to subject characteristics (immunodeficiency, low performance status). The use of HAART improved short-and medium-term survival in HIV-infected patients with cancer, 8 especially those with ADM [13][14][15] and some types of NADM (e.g., HD) 16,17 and reduced the difference from the general population. 8 However, very few studies described 10-year survival in patients with HIV and cancer, and the only published data are limited to subjects with NHL, Kaposi's sarcoma (KS), and anal cancer.…”

Human immunodeficiency and Hodgkin lymphoma

“…While the incidence of HIV-HL has increased concurrently with these therapies outcome been improved dramatically, particularly in cases treated concomitantly with chemotherapy and antiretroviral agents [34], [105], [106] and [107]. For example in a study by Gerard et al [107] a significant increase in disease-free survival of 78% compared to 61% could be demonstrated.…”

“…Similarly in 57 HIV-related HL patients the impact of cART on outcome was tested on survival to different anti-lymphoma schedules [106]. Those who responded by increasing CD4 cell count of 100/ul or a RNA level below 500 copies/ml had an overall survival rate of 89% at 2 years compared with 44% for those who did not meet this criterion or were over 45 years of age [106].…”

“…Those who responded by increasing CD4 cell count of 100/ul or a RNA level below 500 copies/ml had an overall survival rate of 89% at 2 years compared with 44% for those who did not meet this criterion or were over 45 years of age [106]. Interestingly, limited data on the treatment with ABVD combined with cART in HIV-related HL, the standard in the non-immunosuppressed population, are available [106], [108] and [109].…”