HIV-infected patients taking antiretroviral therapy (ART) have a higher risk of developing non-Hodgkin’s lymphoma if they are co-infected with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV).
But the study, “Chronic Hepatitis B and C Virus Infection and Risk for Non-Hodgkin Lymphoma in HIV-Infected Patients: A Cohort Study,” published in Annals of Internal Medicine, shows that this association does not hold true in HIV-infected patients who are not receiving ART.
People infected with HIV are 10 times more likely to develop non-Hodgkin’s lymphoma than those who are HIV-negative. Even in patients taking ART, this is an important cause of AIDS and death.
Several studies have reported that some infections that promote chronic immune stimulation in patients with a compromised immune system increase their risk for non-Hodgkin’s lymphoma.
To understand whether this was the case regarding chronic HBV and HCV infection in HIV-infected patients, researchers at the University Hospital Basel in Switzerland, in collaboration with investigators in Italy, England, Austria, Greece, France, the Netherlands, Demnark, Germany, Spain, and Belgium, examined 18 of the 33 cohorts included in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE).
The study included 52,479 patients who had never received ART, 1,339 (2.6%) of whom had chronic HBV infection and 7,506 (14.3%) of whom had HCV infection.
Among the study participants, 40,219 later started ART. Median follow-up of patients who hadn’t received ART in the past (ART-naive) was 13 months, and for those receiving ART, it was 50 months.
During the course of the study, 252 ART-naive patients developed non-Hodgkin’s lymphoma while 310 patients receiving ART developed the disease, suggesting that ART-naive patients had higher non-Hodgkin’s lymphoma incidence rates than those receiving treatment (219 and 168 per 100,000 person-years, respectively).
However, while those who did not receive ART did not show an association between HBV or HCV infection and non-Hodgkin’s lymphoma development, those receiving ART had 74% and 73% higher chances of developing the disease if infected with HBV or HCV, respectively.
“In HIV-infected patients receiving ART, chronic co-infection with HBV and HCV is associated with an increased risk for [non-Hodgkin’s lymphoma],” the authors wrote.
Although the study’s conclusions may be limited by the fact that many treatment-naive patients later started ART, the researchers believe that early diagnosis of HIV together with routine screening for chronic HBV and HCV infections may decrease non-Hodgkin’s lymphoma morbidity and mortality in people infected with HIV.