Hodgkin lymphoma is as common as non‐ H odgkin lymphoma in HIV ‐positive patients with sustained viral suppression and limited immune deficiency: a prospective cohort study

Objectives The incidence of HIV ‐related non‐ H odgkin lymphoma ( NHL ) but not that of H odgkin lymphoma ( HL ) has been declining. The aim of the study was to compare HIV ‐infected patients with NHL and HL with respect to antiretroviral therapy ( ART ) exposure at the time of lymphoma diagnosis. Methods HIV ‐infected patients with NHL and HL included in a prospective multicentre cohort study since J anuary 2005 were compared with respect to ART exposure and viral load at the time of lymphoma diagnosis. Results As of 31 D ecember 2012, data for 329 patients with NHL and 86 patients with HL from 31 participating centres were available. Patients with HL were more likely to be on ART (73.5% vs. 39.1%, respectively; P  < 0.001) and more frequently had a viral load below the detection limit (57.3% vs. 27.9%, respectively; P  < 0.001) than patients with NHL . The proportion of patients with HL was 8.0% in ART ‐naïve patients, 34.8% in patients with current HIV RNA < 50 HIV ‐1 RNA copies/mL, and 50.0% in patients with both HIV RNA < 50 copies/mL for > 12 months and a CD 4 cell count of > 200 cells/μL. Of note, 45.8% of all patients with NHL were not currently on ART and had a CD 4 count of < 350 cells/μL. Conclusions This prospective cohort study shows that HL was as common as NHL in patients with sustained viral suppression and limited immune deficiency. In contrast to NHL , the majority of patients with HL were on effective ART , suggesting that ART provides insufficient protection from developing HL . The high proportion of untreated patients with NHL suggests missed opportunities for earlier initiation of ART .