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

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.

Biologic, clinical, and sociodemographic predictors of multi-agent systemic therapy for non-Hodgkin lymphoma in people living with HIV: a population-based investigation in the state of Georgia

We conducted a population-based study of biologic, clinical, and sociodemographic factors associated with receipt of multi-agent systemic therapy (MAST) by people living with HIV (PLWH) who were diagnosed with non-Hodgkin lymphoma (NHL). Building on recent registry-based analyses, we linked records from the Georgia Cancer Registry, Georgia HIV/AIDS Surveillance Registry, and the Georgia Hospital Discharge Database to identify 328 PLWH adults (age ≥ 18) diagnosed with NHL within 2004-2012. Through logistic regression modeling, we examined factors associated with patients receiving MAST for NHL. Robust predictors included CD4 count ≥200 cells/mm3 around the time of cancer diagnosis, an advanced stage (III or IV) diagnosis of NHL, MSM HIV transmission, and having private health insurance. The strongest single predictor of MAST was CD4 count. Because there is now guideline-integrated evidence that PLWH receiving standard-of-care cancer therapy can achieve substantially improved outcomes, it is vital they have access to regimens routinely provided to HIV-negative cancer patients.