HIV-infected patients receiving antiretroviral therapy (ART) who are co-infected with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) may have an increased risk for non-Hodgkin's lymphoma, a large European multicohort study found.
Researchers studied 18 of 33 cohorts from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) to investigate whether chronic HBV and HCV infection are associated with increased incidence of non-Hodgkin's lymphoma. The study results were published by Annals of Internal Medicine on Oct. 18.
Some patients had HBV, HCV, or dual infection at the time of cohort inclusion, and others acquired infection during the follow-up phase. There were 52,479 treatment-naive patients (2.6% with chronic HBV infection and 14.3% with HCV infection); of these, 40,219 (77%) later started ART. Median follow-up was 13 months for treatment-naive patients and 50 months for those receiving ART.
A total of 252 treatment-naive patients and 310 treated patients developed non-Hodgkin's lymphoma, with incidence rates of 219 and 168 cases per 100,000 person-years, respectively. The hazard ratios for non-Hodgkin's lymphoma with HBV and HCV infection were 1.33 (95% CI, 0.69 to 2.56) and 0.67 (95% CI, 0.40 to 1.12), respectively, in treatment-naive patients and 1.74 (95% CI, 1.08 to 2.82) and 1.73 (95% CI, 1.21 to 2.46), respectively, in treated patients.
The researchers noted that early diagnosis and treatment of HIV infection in conjunction with routine screening for chronic HBV or HCV infection is essential to further decrease non-Hodgkin's lymphoma morbidity and mortality in HIV-infected persons.
“Our findings provide strong evidence that HCV co-infected patients with poor immune status or restoration (CD4 count <0.250 × 109 cells/L) are at high risk for NHL [non-Hodgkin's lymphoma] and death and deserve high priority for access to well-tolerated, interferon-free, direct-acting antiviral treatment programs similar to those for patients with advanced liver fibrosis or cirrhosis,” they wrote.