HOUSTON — Diagnosis and treatment of both HIV and Burkitt lymphoma has significantly improved in the last two decades, although HIV patients remain at high risk for the lymphoma.
A report in the Journal of Acquired Immune Deficiency Syndrome discussed the results of an evaluation of changes in risk of or survival after BL diagnosis among HIV patients during the anti-retroviral era. 1
Researchers from the Baylor College of Medicine and the Michael E. DeBakey VA Health Services Research Center of Innovations retrospectively identified veterans living with HIV, as well as age-matched HIV-negative controls receiving care between 1999-2016 in the VHA.
Burkitt diagnoses were identified through VHA Cancer Registry review and ICD-9/10 codes, while demographic, lifestyle, and clinical variables came from electronic medical records. With 45,299 veterans with HIV documented, 84 of those were found to have developed BL (incidence rate [IR] = 21.2 per 100,000 person years, CI: 17.1-26.3). Median CD4 count at BL diagnosis was 238 cells/mL (SD: 324.74) and increased over time, according to the article.
Investigators determined that survival was truncated in veterans with both HIV and Burkitt lymphoma (p<0.05) and also discovered that the risk of BL in those veterans was 38% less in blacks compared with whites (HR: 0.620, CI0.393-0.979, p=0.0401).
The study team calculated that veterans with HIV who had an undetectable viral load for at least 40% of follow up were 74% less likely to develop BL (HR: 0.261, CI 0.143-0.478, p<0.0001) and 86% less likely to die after diagnosis (HR: 0.141, CI 0.058-0.348, p<0.0001).
“BL incidence among VLWH did not improve between 2000 and 2016,” the authors concluded. “Survival after BL diagnosis in VLWH remains dismal as compared to their HIV-negative counterparts, although veterans with prolonged periods of undetectable viral load had improved prognosis.”
- Clark E, Royse KE, Dong Y, et al. Stable Incidence and Poor Survival for HIV-Related Burkitt Lymphoma Among the U.S. Veteran Population During the Anti-Retroviral Era [published online ahead of print, 2020 Jan 27]. J Acquir Immune Defic Syndr. 2020;10.1097/QAI.0000000000002303. doi:10.1097/QAI.0000000000002303