Longer duration of combination antiretroviral therapy reduces the risk of Hodgkin lymphoma: A cohort study of HIV-infected male veterans

• We modeled aggregate cART use in a cohort of HIV-infected males from the Veterans Affairs HIV Clinical Case Registry.
• Poisson regression was used to examine the effects of cART duration on Hodgkin lymphoma incidence.
• Long-term use of cART, non-specific to therapy regimen, was associated with decreased Hodgkin lymphoma risk.
• Hodgkin lymphoma incidence was highest directly following cART initiation.
• Research is needed to understand the mechanisms impacting immune reconstitution and lymphomagenesis after beginning cART.

BackgroundHodgkin lymphoma (HL) incidence has increased since combined antiretroviral therapy (cART) introduction. It is unclear how different cART classes (e.g., protease inhibitors (PI), non-nucleoside reverse transcription inhibitors (NNRTI)) influence HL. This study aimed to determine the effects of cART duration on HL incidence among HIV-infected veterans.MethodsWe performed a retrospective cohort study utilizing the Veterans Affairs HIV Clinical Case Registry (1985–2010). HL cases were identified using ICD-9 codes (201.4-9). cART, PI, and NNRTI duration was the aggregate number of treatment days delivered. Incidence rates (IR) and rate ratios (IRR) were calculated from Poisson regression models to examine the effects of cART duration on HL.Results31,576 cART users contributed 288,736 person-years (PY) and 211 HL cases (IR = 7.3/10,000 person-years). HL incidence decreased from 25.1/10,000 PY (95%CI = 18.9–33.4) within the first year of cART to 0.6/10,000 PY (95%CI = 0.3–1.6) after ≥10 years. In multivariable models, each additional year of cART was associated with decreased HL incidence (IRR = 0.80; 95%CI = 0.75–0.86); similar effects were observed in models assessing HL incidence by PI and NNRTI.ConclusionOur findings indicate long-term cART of any class is associated with decreased HL risk. High HL incidence directly following cART initiation supports a potential immune reconstitution mechanism in HIV-related HL. Further research is needed to evaluate the interaction between early cART, immune reconstitution, and HL.