HIV Related Hodgkin's Lymphoma in the HAART Era: A Comprehensive Review and Meta-Analysis of Response and Survival Rates.
Authors: Sunil Meena , Mixon Tarisha , Reid Erin , Lechowicz Mary Jo 
Published: October 2019

Abstract
Abstract 1652
Poster Board I-678

Introduction
Hodgkin lymphoma (HL) is one of the most common non-acquired immunodeficiency syndrome (AIDS)-defining tumors in human immunodeficiency virus (HIV)-infected patients. Studies have shown that HIV infected individuals have approximately a 7.5-fold (Goedert et al 1998) to nearly 13-fold increased risk for HL compared with the general population (Biggar et al. 2006, Engels 2006). The outcomes for patients with HL and HIV (HIV-HL) were described as inferior to HIV-negative patients. The existing literature regarding response and survival data is mainly comprised of small and/or retrospective studies. We reviewed the literature for the purpose of examining a larger HIV HL cohort for response rates and survival in the HAART era.

Methods
We searched PUBMED, OVID & Google Scholar (1980- July 2009) and ASH (2004-2008) & ASCO (2004-2009) Annual Meeting Abstracts. Key words used were ‘Hodgkin's Lymphoma’, ‘Hodgkin's Disease',’ HIV/AIDS', HAART, therapeutic outcomes, concomitant chemotherapy & HAART/antiretroviral therapy, non AIDS malignancies. Criteria for inclusion of studies were: 1) Upfront treatment of HL HIV infected patients with chemotherapy, with or without radiotherapy, with or without antiretroviral drugs/ HAART. 2) Reported in English 3) Studies with outcome measures of treatment for HIV-HL patients such as complete response (CR) rates, and/or at least one type of survival statistic. We also examined references from above articles as well as review articles, studies on pathogenesis & histologic features of HIV-HL, and epidemiologic studies for additional references. Studies that did not clearly report on a comprehensive cohort were excluded given increased probability of reporting bias. Primary outcome measures were CR rates, and 1- and 2-year overall survival rates. The data extracted included pre-treatment patient characteristics such as median age, sex, histological diagnosis, clinical staging, site of involvement, median CD4 cell counts, treatment regimen used, use or not of antiretrovirals/HAART & prophylactic agents with chemotherapy, response to treatment, toxicity, opportunistic infections, median follow up time, relapse, disease progression, death from treatment or infections. Summary CR and OS estimates were calculated based on the assumption of fixed effects and using the Mantel-Haenszel method.

Results
12 articles met inclusion criteria for meta-analysis of CR and/or OS. The overall CR rate was 72% (95% CI 67-77%) with 1- and 2-year OS of 78% (95% CI 73-82%) and 69% (95% CI 67-77%), respectively (Figure 1). Advanced stage was present in 63%, and histology other than nodular sclerosing in 76%. Mean baseline CD4 count was 212 (3-887); 59% of subject received HAART with chemotherapy. Death during treatment occurred in 7% and relapse was reported in 14%.

Conclusions
Adverse baseline characteristics including advanced disease and histology other than NS persist in the HAART era. Response and survival rates are improved compared to pre-HAART era but remain lower than rates found in the HIV-negative population. Further prospective trials need to be done to examine improvements in treatment for this patient population.

Disclosures
No relevant conflicts of interest to declare.