Assessment of immunovirological features in HIV related non-Hodgkin lymphoma patients and their impact on outcome

Background: Despite the era of highly active antiretroviral therapy, non-Hodgkin lymphoma (NHL) remains one of the main causes of death in HIV-infected patients, with a wide variation on the outcome. Objectives: We investigated immunological status and EBV, HHV8, HIV viral load in a group of HIV-infected patients at diagnosis of NHL to evaluate their prognostic significance. Study design: Eighty-one consecutive HIV+ NHL patients were studied. CD4 and CD8 cell counts, HHV8 DNA, EBV DNA, HIV RNA and HIV DNA were assessed at diagnosis and at 3 months after chemotherapy initiation. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of disease free survival (DFS) and overall survival (OS) were computed according to CD4 and CD8 cell counts, EBV DNA, HIV RNA and HIV DNA. HRs were, thereafter, computed also for continuous variation of CD4, CD8 cell counts and EBV DNA. Results: In the multivariate analysis, CD4 <160 and CD8 <590. cell/μl and EBV DNA ≥ 300. c/ml were independently associated to DFS (HR = 2.98; 95%CI: 1.26-7.03; HR = 2.65, 95%CI: 1.13-6.19; HR = 4.01; 95%CI: 1.81-8.91) and OS (HR = 3.32; 95%CI: 1.41-7.83; HR = 4.62, 95%CI: 1.91-11.19; HR = 3.11, 95%CI: 1.42-6.80). HRs for DFS and OS decreased continuously with increasing CD4 and CD8 cell counts, while they increased continuously with increasing EBV DNA levels. Conclusions: The association with survival of low CD4 and CD8 cell counts and detectable EBV viremia, measured at lymphoma's diagnosis, identified three independent prognostic biomarkers that might help in the management of NHL HIV+ patients, offering complementary information in the ascertainment of their outcome.