CD4+ and CD8+ T-cell kinetics in aviremic HIV-infected patients developing Hodgkin or non-Hodgkin lymphoma
Hoffmann C et al.
AIDS. 2016 Mar 13;30(5):753-60.
The risk of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) is increased in HIV-infected individuals. This study evaluated the kinetics of lymphocyte subsets in patients who subsequently developed HL or NHL while on virologically suppressive antiretroviral therapy (ART).
Using a nested case–control design, cases of HIV+ HL or NHL were selected from two prospective clinical studies. Aviremia was defined as less than 200 HIV-RNA copies/ml for at least 6 months prior to lymphoma diagnosis. Each case was matched to three aviremic HIV+ controls without lymphoma. Controls were matched on the following: sex; age at the time of first viral suppression (± 5 years); CD4 + T-cell nadir (± 50 cells/µl); length of viral suppression. The reference date was defined as the date of lymphoma diagnosis in cases and the date after a similar duration of viral suppression in controls. For controls, a lymphoma-free time period of at least 2 years after the reference date was required with no evidence of malignant disease or exposure to immunosuppressive drugs (including hepatitis C therapy) during the observation period.
In the 81 cases (50 HL and 31 NHL), pre-diagnostic CD4 + T cells and CD8 + T cells displayed discordant kinetics compared with controls.
- • Within the last and within the next-to-last year preceding HL diagnosis, mean CD4 + T cells decreased by -168 and by -2 cells/µl, compared with an increase of +44 and +73 cells/µl in the controls, respectively. Mean CD8 + T cells decreased by -352 and -115 cells/µl, compared with non significant changes of -29 and ± 0 cells/µl in the controls, respectively.
- • Kinetics of CD4 + and CD8 + T cells were also discordant between NHL cases and controls, with non-significant mean change in CD4 in the year preceding lymphoma diagnosis, by -17.1 and + 25.1 cells/µl, respectively. Between year 2 and 1 prior to NHL diagnosis, mean change of CD4 was – 41.9 cells/µl vs + 80.8 cells/µl in controls. In NHL patients, CD8 + T cells decreased were - 184 and - 116 cells/µl in the early (Year -2 to Year -1) an late period (year preceding lymphoma), respectively. In the matched controls, no significant changes were seen in either period.
- • There was marked variability in CD4+ kinetics, as 37% of HL cases had no decline or even an increase of their CD4 + T cells.
In conclusion: A discordant kinetics of both CD4 + and CD8 + T cells was seen 1–2 years prior to lymphoma diagnosis (HL or NHL), with more pronounced decrease during the last year and in patients developing HL
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