Lower 5-year survival among HIV-positive vs. HIV-negative Hodgkin lymphoma patients is largely attributable to a high rate of non-treatment among those who are HIV positive, a review of cases from the National Cancer Data Base suggests.
Of 2,090 HIV-associated Hodgkin lymphoma patients diagnosed between 2004 and 2012 and included in the database, 81% received chemotherapy, and 13% received radiation therapy, but 16% received no treatment. Survival was 66% compared with 80% survival among HIV-negative Hodgkin lymphoma patients, reported Dr. Adam J. Olszewski of Brown University, Providence, R.I. and Dr. Jorge J. Castillo of Harvard Medical School, Boston (AIDS. 2016 Jan 4. doi: 10.1097/QAD.0000000000000986).
Another factor that contributed to the disparity was poor prognosis in patients with undetermined histologic subtype.
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Among patients who received chemotherapy, HIV-positive status was not significantly associated with increased mortality in those with classical histologic subtypes, the authors said.
For example, the hazard ratios for mortality were 1.08 for nodular sclerosis and 1.06 for mixed cellularity. Those with undetermined histology had a significantly worse prognosis (hazard ratio, 1.56), and particular attention should be paid to these patients given their worse prognosis and high risk of nontreatment, the authors said.
Factors found on logistic regression analysis to be associated with higher risk of nontreatment among all patients were advanced age, male sex, nonwhite race, poor socioeconomic status, and undetermined histologic subtype. In 2012, the majority of HIV-positive patients were of nonwhite race; nearly half (49%) were black – an increase from 31% in 2004, and 15% were Hispanic, which raises additional concerns about the disparity in treatment delivery between HIV-positive and HIV-negative patients with Hodgkin lymphoma, they noted.
Dr. Olszewski is supported by the American Society of Hematology Scholar Award and the American Cancer Society Research Scholar Award. Both authors reported having no relevant conflicts of interest.