PMID- 24755860 OWN - NLM STAT- MEDLINE DCOM- 20150817 LR - 20240217 IS - 1537-6591 (Electronic) IS - 1058-4838 (Print) IS - 1058-4838 (Linking) VI - 59 IP - 2 DP - 2014 Jul 15 TI - Lymphoma immune reconstitution inflammatory syndrome in the center for AIDS research network of integrated clinical systems cohort. PG - 279-86 LID - 10.1093/cid/ciu270 [doi] AB - BACKGROUND: Lymphoma incidence is increased among human immunodeficiency virus (HIV)-infected individuals soon after antiretroviral therapy (ART), perhaps due to unmasking immune reconstitution inflammatory syndrome (IRIS). Clinical characteristics and survival for unmasking lymphoma IRIS have not been described. METHODS: We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) from 1996 until 2011. Unmasking lymphoma IRIS was defined as lymphoma within 6 months after ART accompanied by a >/= 0.5 log10 copies/mL HIV RNA reduction. Differences in presentation and survival were examined between IRIS and non-IRIS cases. RESULTS: Of 482 lymphoma patients, 56 (12%) met criteria for unmasking lymphoma IRIS. Of these, 12 (21%) had Hodgkin lymphoma, 22 (39%) diffuse large B-cell lymphoma, 5 (9%) Burkitt lymphoma, 10 (18%) primary central nervous system lymphoma, and 7 (13%) other non-Hodgkin lymphoma. Median CD4 cell count at lymphoma diagnosis among IRIS cases was 173 cells/microL (interquartile range, 73-302), and 48% had suppressed HIV RNA <400 copies/mL. IRIS cases were similar overall to non-IRIS cases in histologic distribution and clinical characteristics, excepting more frequent hepatitis B and C (30% vs 19%, P = .05), and lower HIV RNA at lymphoma diagnosis resulting from the IRIS case definition. Overall survival at 5 years was similar between IRIS (49%; 95% confidence interval [CI], 37%-64%) and non-IRIS (44%; 95% CI, 39%-50%), although increased early mortality was suggested among IRIS cases. CONCLUSIONS: In a large HIV-associated lymphoma cohort, 12% of patients met a uniformly applied unmasking lymphoma IRIS case definition. Detailed studies of lymphoma IRIS might identify immunologic mechanisms of lymphoma control. CI - (c) The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. FAU - Gopal, Satish AU - Gopal S AD - University of North Carolina at Chapel Hill. FAU - Patel, Monita R AU - Patel MR AD - University of North Carolina at Chapel Hill. FAU - Achenbach, Chad J AU - Achenbach CJ AD - Northwestern University, Chicago, Illinois. FAU - Yanik, Elizabeth L AU - Yanik EL AD - University of North Carolina at Chapel Hill. FAU - Cole, Stephen R AU - Cole SR AD - University of North Carolina at Chapel Hill. FAU - Napravnik, Sonia AU - Napravnik S AD - University of North Carolina at Chapel Hill. FAU - Burkholder, Greer A AU - Burkholder GA AD - University of Alabama at Birmingham. FAU - Mathews, W Christopher AU - Mathews WC AD - University of California, San Diego. FAU - Rodriguez, Benigno AU - Rodriguez B AD - Case Western Reserve University, Cleveland, Ohio. FAU - Deeks, Steven G AU - Deeks SG AD - University of California, San Francisco. FAU - Mayer, Kenneth H AU - Mayer KH AD - Fenway Health, Boston, Massachusetts. FAU - Moore, Richard D AU - Moore RD AD - Johns Hopkins University, Baltimore, Maryland. FAU - Kitahata, Mari M AU - Kitahata MM AD - University of Washington, Seattle. FAU - Richards, Kristy L AU - Richards KL AD - University of North Carolina at Chapel Hill. FAU - Eron, Joseph J AU - Eron JJ AD - University of North Carolina at Chapel Hill. LA - eng GR - P30 AI027767/AI/NIAID NIH HHS/United States GR - K01 TW009488/TW/FIC NIH HHS/United States GR - P30 AI094189/AI/NIAID NIH HHS/United States GR - P30AI094189/AI/NIAID NIH HHS/United States GR - R24 AI067039/AI/NIAID NIH HHS/United States GR - K01TW009488/TW/FIC NIH HHS/United States GR - P30AI50410/AI/NIAID NIH HHS/United States GR - P30CA016086/CA/NCI NIH HHS/United States GR - R21CA180815/CA/NCI NIH HHS/United States GR - T32 AI070114/AI/NIAID NIH HHS/United States GR - P30 AI036219/AI/NIAID NIH HHS/United States GR - P30AI36219/AI/NIAID NIH HHS/United States GR - U01 DA036935/DA/NIDA NIH HHS/United States GR - T32 AI007140/AI/NIAID NIH HHS/United States GR - U01CA121947/CA/NCI NIH HHS/United States GR - P30 CA016086/CA/NCI NIH HHS/United States GR - P30AI027767/AI/NIAID NIH HHS/United States GR - P30 AI027763/AI/NIAID NIH HHS/United States GR - U01 AI069918/AI/NIAID NIH HHS/United States GR - R24AI067039/AI/NIAID NIH HHS/United States GR - U01 CA121947/CA/NCI NIH HHS/United States GR - P30 AI050410/AI/NIAID NIH HHS/United States GR - R21 CA180815/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20140421 PL - United States TA - Clin Infect Dis JT - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JID - 9203213 SB - IM MH - Acquired Immunodeficiency Syndrome/*complications/*drug therapy MH - Adolescent MH - Adult MH - Cohort Studies MH - Female MH - Humans MH - Immune Reconstitution Inflammatory Syndrome/*epidemiology/mortality MH - Incidence MH - Lymphoma/*epidemiology/mortality MH - Male MH - Middle Aged MH - Survival Analysis MH - Young Adult PMC - PMC4102912 OTO - NOTNLM OT - HIV/AIDS OT - Hodgkin lymphoma OT - immune reconstitution inflammatory syndrome OT - lymphoma OT - non-Hodgkin lymphoma EDAT- 2014/04/24 06:00 MHDA- 2015/08/19 06:00 PMCR- 2015/07/15 CRDT- 2014/04/24 06:00 PHST- 2014/04/24 06:00 [entrez] PHST- 2014/04/24 06:00 [pubmed] PHST- 2015/08/19 06:00 [medline] PHST- 2015/07/15 00:00 [pmc-release] AID - ciu270 [pii] AID - 10.1093/cid/ciu270 [doi] PST - ppublish SO - Clin Infect Dis. 2014 Jul 15;59(2):279-86. doi: 10.1093/cid/ciu270. Epub 2014 Apr 21.