Association of early HIV viremia with mortality after HIV-associated lymphoma

AIDS. 2013 Sep 24;27(15):2365-73. doi: 10.1097/QAD.0b013e3283635232.


Objective: To examine the association between early HIV viremia and mortality after HIV-associated lymphoma.

Design: Multicenter observational cohort study.

Setting: Center for AIDS Research Network of Integrated Clinical Systems cohort.

Participants: HIV-infected patients with lymphoma diagnosed between 1996 and 2011, who were alive 6 months after lymphoma diagnosis and with at least two HIV RNA values during the 6 months after lymphoma diagnosis.

Exposure: Cumulative HIV viremia during the 6 months after lymphoma diagnosis, expressed as viremia copy-6-months.

Main outcome measure: All-cause mortality between 6 months and 5 years after lymphoma diagnosis.

Results: Of 224 included patients, 183 (82%) had non-Hodgkin lymphoma (NHL) and 41 (18%) had Hodgkin lymphoma. At lymphoma diagnosis, 105 (47%) patients were on antiretroviral therapy (ART), median CD4⁺ cell count was 148 cells/μl (interquartile range 54-322), and 33% had suppressed HIV RNA (<400 copies/ml). In adjusted analyses, mortality was associated with older age [adjusted hazard ratio (AHR) 1.37 per decade increase, 95% CI 1.03-1.83], lymphoma occurrence on ART (AHR 1.63, 95% CI 1.02-2.63), lower CD4⁺ cell count (AHR 0.75 per 100 cells/μl increase, 95% CI 0.64-0.89), and higher early cumulative viremia (AHR 1.35 per log₁₀ copies × 6-months/ml, 95% CI 1.11-1.65). The detrimental effect of early cumulative viremia was consistent across patient groups defined by ART status, CD4⁺ cell count, and histology.

Conclusion: Exposure to each additional 1-unit log₁₀ in HIV RNA throughout the 6 months after lymphoma diagnosis was associated with a 35% increase in subsequent mortality. These results suggest that early and effective ART during chemotherapy may improve survival.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Female
  • Hodgkin Disease / drug therapy
  • Hodgkin Disease / mortality*
  • Humans
  • Lymphoma, AIDS-Related / drug therapy
  • Lymphoma, AIDS-Related / mortality*
  • Lymphoma, Non-Hodgkin / drug therapy
  • Lymphoma, Non-Hodgkin / mortality*
  • Male
  • Middle Aged
  • RNA, Viral / blood*
  • Risk Factors
  • Viral Load
  • Viremia / drug therapy
  • Viremia / mortality*


  • Anti-Retroviral Agents
  • RNA, Viral