Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
Non-Hodgkin's lymphoma among people with AIDS: incidence, presentation and public health burden. AIDS/Cancer Study Group.
Int J Cancer. 1997 Nov 27;73(5):645-50. Unique Identifier : AIDSLINE MED/98058682 Cote TR; Biggar RJ; Rosenberg PS; Devesa SS; Percy C; Yellin FJ; Lemp G; Hardy C; Geodert JJ; Blattner WA; Viral Epidemiology Branch, Division of Cancer Etiology, National; Cancer Institute, Rockville, MD, USA.
Abstract:
We describe the anatomic and histologic presentation and prognosis of non-Hodgkin's lymphoma (NHL) among people with AIDS PWA) and determine their contribution to the NHL burden. We linked AIDS and cancer registries in selected areas of the United States and compared NHL sites and histologies in PWA and non-PWA, after adjusting for age, sex and ethnicity. Among 51,033 PWA, we found 2,156 cases of NHL (4.3%). Half of NHL cases occurring post-AIDS were not reported to AIDS registries. NHL was part of an AIDS-defining condition for 3.2% of all PWA; the relative risk of NHL with 3.5 years of another AIDS diagnosis was 165-fold compared to non-PWA within the cancer surveillance system. Of NHLs, 39% were high grade (vs. 12% among non-PWA), 60% were nodal vs. 74% among non-PWA) and 15% had brain primaries (vs. 1% among non-PWA). Excluding brain sites, extranodal sites were still 20% more common than expected. Relative risk was elevated for all histologic types, with the risk ranging from 652-fold for high-grade diffuse immunoblastic tumors and 261-fold for Burkitt's lymphomas to 113 for intermediate-grade lymphoma to 14-fold for low-grade lymphoma. Survival among PWA with NHL was poor, and tumor grade had little impact. In high-risk AIDS areas, AIDS-related NHLs constitute a major share of the NHL burden. We conclude that NHL risk is considerably under-estimated in AIDS registry data. The major differences between PWA and non-PWA were the high frequency of brain lymphoma and the increase in high-grade lymphomas in PWA. However, the grade of NHL did not influence the prognosis among PWA with lymphoma. The increasing risk of NHL in PWA has contributed substantially to the general increase in NHL rates in the United States since 1981.
Keywords: *Cost of Illness *Lymphoma, AIDS-Related/EPIDEMIOLOGY *Lymphoma, Non-Hodgkin/EPIDEMIOLOGY *Public Health/STATISTICS & NUMER DATA 980330
M9831194
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Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
