Impact of multi-agent systemic therapy on all-cause and disease-specific survival for people living with HIV who are diagnosed with non-Hodgkin lymphoma: population-based analyses from the state of Georgia

Abstract

For people living with HIV (PLWH) who are subsequently diagnosed with non-Hodgkin lymphoma (NHL), we investigate the impact of standard-of-care (SoC) cancer treatment on all-cause, NHL-specific, and HIV-specific survival outcomes. The focus is on a registry-derived, population-based sample of HIV + adults diagnosed with NHL within 2004–2012 in the state of Georgia. SoC treatment is defined as receipt of multi-agent systemic therapy (MAST). In multivariable survival analyses, SoC cancer treatment is significantly associated with better all-cause and NHL-specific survival, but not better HIV-specific survival across 2004–2017. Having a CD4 count <200 near the time of cancer diagnosis and Ann Arbor stage III/IV disease are associated with worse all-cause and HIV-specific survival; the effects on NHL survival trend negative but are not significant. Future work should expand the geographic base and cancers examined, deepen the level of clinical detail brought to bear, and incorporate the perspectives and recommendations of patients and providers.

Keywords:

• Non-Hodgson lymphoma
• HIV/AIDS
• standard-of-care therapy
• survival analysis
• competing risks
• outcomes research

Acknowledgments

The paper has benefited significantly from the comments and recommendations from two anonymous reviewers.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported in part by NIH Grant [P30AI050409] to the Emory Center for AIDS Research, with additional funding from the Winship Cancer Institute of Emory University. The collection of cancer incidence data in Georgia was supported by contract [HHSN261201800003I], Task Order [HHSN26100001] from the National Cancer Institute and cooperative agreement [5NU58DP003875-04] from the Centers for Disease Control and Prevention. The research reported in this paper was supported in part by the Biostatistics and Bioinformatics Shared Resource of the Winship Cancer Institute and the National Cancer Institute under award number [P30CA138292]. The contents are solely the responsibilities of the authors and do not necessarily represent the official views of the NCI, the CDC, or the GA Department of Public Health.