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Clark E, Royse KE, Dong Y, Chang E, Raychaudhury S, Kramer J, White DL, Chiao E. Stable Incidence and Poor Survival for HIV-Related Burkitt Lymphoma Among the U.S. Veteran Population During the Anti-Retroviral Era. Journal of acquired immune deficiency syndromes (1999). 2020 Jan 27.
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Abstract: BACKGROUND: Despite advances in diagnosis and treatment of both HIV and Burkitt lymphoma (BL), persons living with HIV (PLWH) remain at high risk for BL. We conducted this study to evaluate if there have been any changes in risk of or survival after BL diagnosis among PLWH during the anti-retroviral era. SETTING: Veterans living with HIV (VLWH) and age-matched HIV-negative controls receiving care between 1999-2016 were retrospectively identified using Veterans Health Administration (VHA) electronic medical records (EMR). METHODS: We identified BL diagnoses through VHA Cancer Registry review and ICD-9/10 codes and we extracted demographic, lifestyle, and clinical variables from EMR. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for BL risk and survival using Cox proportional models. RESULTS: We identified 45,299 VLWH. Eighty-four developed BL (incidence rate [IR] = 21.2 per 100,000 person years, CI: 17.1-26.3). Median CD4 count at BL diagnosis was 238 cells/mL (SD: 324.74) and increased over time. Survival was truncated in VLWH with BL (p < 0.05). The risk of BL in VLWH was 38% less in blacks compared with whites (HR: 0.620, CI0.393-0.979, p = 0.0401). VLWH with an undetectable viral load for at least 40% of follow up were 74% less likely to develop BL (HR: 0.261, CI 0.143-0.478, p < 0.0001) and 86% less likely to die after diagnosis (HR: 0.141, CI 0.058-0.348, p < 0.0001). CONCLUSIONS: BL incidence among VLWH did not improve between 2000 and 2016. Survival after BL diagnosis in VLWH remains dismal as compared to their HIV-negative counterparts, although veterans with prolonged periods of undetectable viral load had improved prognosis.

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