In high-income countries, the availability of HAART has led to dramatic decreases in deaths from many AIDS-related complications, particularly infections. However, decreases in the risk for certain cancers, such as those of the lymphatic system — NHL or non-Hodgkin's lymphoma — have not been as dramatic in the first few years after HAART was released.

CASCADE

In 2002, researchers in Canada, Australia and the European Union worked together on a giant database called CASCADE, collecting thousands of medical records on HIV positive people. One of the results of this work is a re-evaluation of the impact of HAART on the risk of developing NHL. Researchers analysed data on 7,103 subjects over three periods of time as follows:

• 1996
• 1997-1998
• 1999-2002

In reviewing the data, researchers specifically looked at the following factors:

• the CD4+ count at the time NHL was diagnosed
• the lowest CD4+ count a person ever had

Results

• During the study period, 93 cases of NHL in 7,103 subjects occurred.
• PHAs whose CD4+ counts were below the 100 cell mark were at greatest risk of developing NHL.
• The risk of developing NHL fell significantly in the time 1999-2002 compared to in previous years.
• A person's history of CD4+ cell count changes (eg. lowest-ever CD4+ count) did not significantly affect their risk of developing NHL in this study. What mattered the most was the current CD4+ count.

These findings may be of some comfort to HAART users. However, the recovery of the immune system seen with HAART is incomplete and so some risk from NHL remains.

REFERENCE

Bhaskaran K, et al. Incidence and predictors of non-Hodgkin lymphoma in European cohorts of HIV seroconverters. Sixth International Congress on Drug Therapy in HIV Infection, 17-21 November 2002, Glasgow Plenary Lecture 7.4

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