Incidence, treatment and outcome of HIV-associated hematologic malignancies in people living with HIV in Sweden.

Abstract

Background: People living with HIV (PLHIV) have an increased risk of hematologic malignancies (HMs). We aimed to characterize HMs among PLHIV at Karolinska University Hospital, Stockholm, Sweden. Methods: We studied all PLHIV receiving care at our center between 2004-2018. Data was retrieved retrospectively from InfCareHIV database and medical records. Results: 3,484 patients received HIV care for a total of 22,903 person-years (py) with median follow-up of 7.6 years. HMs were identified in 43 patients with 30 cases of Non-Hodgkin lymphoma (NHL), 9 cases of Hodgkin lymphoma (HL), two multicentric Castleman s disease, one case each of myeloma and myelodysplastic syndrome. The incidence rate of NHL was 88/105 py and HL 39.6/105 py. The incidence of NHL declined 2004-2010 vs 2011-2018 (180.8 vs 40.1/105 py; p=0.001). Median time from HIV diagnosis to malignancy was shorter in NHL compared to HL (1.2 vs 8.9 years; p=0.01) and effective HIV treatment was less common in NHL (33% vs 100%; p<0.001). The five-year survival rate of NHL was 59% and HL 43%, significantly lower compared to lymphoma survival in the general population in Sweden. Conclusions: In the era of effective antiretroviral therapy (ART) the incidence rate of lymphoma was more than five times higher in PLHIV and five-year survival significantly inferior. Efforts for earlier identification of HIV infected individuals are likely to affect the incidence of NHL. Additionally, an effective screening for clinical and laboratory signs of HL in PLHIV on ART should be introduced to improve identification and survival of HL in this population.