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Chronic Hepatitis B and C Virus Infection and Risk for Non-Hodgkin Lymphoma in HIV-Infected Patients: A Cohort Study.

Chronic Hepatitis B and C Virus Infection and Risk for Non-Hodgkin Lymphoma in HIV-Infected Patients: A Cohort Study.
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Wang Q, De Luca A, Smith C, Zangerle R, Sambatakou H, Bonnet F, Smit C, Schommers P, Thornton A, Berenguer J, Peters L, Spagnuolo V, Ammassari A, Antinori A, Roldan EQ, Mussini C, Miro JM, Konopnicki D, Fehr J, Campbell MA, Termote M, Bucher HC, ,


Wang Q, De Luca A, Smith C, Zangerle R, Sambatakou H, Bonnet F, Smit C, Schommers P, Thornton A, Berenguer J, Peters L, Spagnuolo V, Ammassari A, Antinori A, Roldan EQ, Mussini C, Miro JM, Konopnicki D, Fehr J, Campbell MA, Termote M, Bucher HC, , (click to view)

Wang Q, De Luca A, Smith C, Zangerle R, Sambatakou H, Bonnet F, Smit C, Schommers P, Thornton A, Berenguer J, Peters L, Spagnuolo V, Ammassari A, Antinori A, Roldan EQ, Mussini C, Miro JM, Konopnicki D, Fehr J, Campbell MA, Termote M, Bucher HC, ,

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Annals of internal medicine 2016 Oct 18() doi 10.7326/M16-0240

Abstract
Background
Non-Hodgkin lymphoma (NHL) is the most common AIDS-defining condition in the era of antiretroviral therapy (ART). Whether chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection promote NHL in HIV-infected patients is unclear.

Objective
To investigate whether chronic HBV and HCV infection are associated with increased incidence of NHL in HIV-infected patients.

Design
Cohort study.

Setting
18 of 33 cohorts from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE).

Patients
HIV-infected patients with information on HBV surface antigen measurements and detectable HCV RNA, or a positive HCV antibody test result if HCV RNA measurements were not available.

Measurements
Time-dependent Cox models to assess risk for NHL in treatment-naive patients and those initiating ART, with inverse probability weighting to control for informative censoring.

Results
A total of 52 479 treatment-naive patients (1339 [2.6%] with chronic HBV infection and 7506 [14.3%] with HCV infection) were included, of whom 40 219 (77%) later started ART. The median follow-up was 13 months for treatment-naive patients and 50 months for those receiving ART. A total of 252 treatment-naive patients and 310 treated patients developed NHL, with incidence rates of 219 and 168 cases per 100 000 person-years, respectively. The hazard ratios for NHL with HBV and HCV infection were 1.33 (95% CI, 0.69 to 2.56) and 0.67 (CI, 0.40 to 1.12), respectively, in treatment-naive patients and 1.74 (CI, 1.08 to 2.82) and 1.73 (CI, 1.21 to 2.46), respectively, in treated patients.

Limitation
Many treatment-naive patients later initiated ART, which limited the study of the associations of chronic HBV and HCV infection with NHL in this patient group.

Conclusion
In HIV-infected patients receiving ART, chronic co-infection with HBV and HCV is associated with an increased risk for NHL.

Primary Funding Source
European Union Seventh Framework Programme.

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