The morbidity and mortality of people living with HIV have been dramatically improved with the advent of highly active antiretroviral therapy (HAART). However, the incidence of AIDS-related lymphoma (ARL) has not declined as significantly and some studies report no change or even an increase in the incidence of ARL in the HAART era. We compared the epidemiologic, immunologic, and clinical characteristics of patients diagnosed with ARL in the pre-HAART and HAART eras. We used the Adult/Adolescent Spectrum of HIV-related Diseases database of Public Health—Seattle and King County to determine incidences and trends among patients diagnosed with ARL in King County, WA. We noted a significant decline in the incidence of ARL among AIDS patients from 37 patients per 1,000 person-years in the pre-HAART era to 8 patients per 1,000 person-years in the HAART era (p < .01). There was a significant increase in the percentage of females (2% vs 14%, p < .01) and minorities (blacks 9% vs 29%, p < .01; Hispanics 6% vs 21%, p < .01; Native Americans 0 vs 14%, p < .01) in the HAART era. There was also a significant increase in the percentage of ARL patients who contracted HIV through other modes of exposure, including heterosexual transmission (8% vs 36%, p < .01). Immunologically, there was a significant increase in the percentage of patients diagnosed with ARL at CD4+ counts ≥ 200 cells/μL (3% vs 21%, p < .01) and a large decline in the median HIV-1 viral loads at ARL diagnosis (264,667 vs 35,500 copies/mL). In addition, the history of opportunistic illnesses in ARL patients declined significantly (83% vs 36%, p < .01). The risk of dying among ARL patients in the HAART era was significantly lower (p < .01) than ARL patients in the pre-HAART era. Hepatitis B (4% vs 7%, p = .35) and C (2% vs 0%, p = .50) virus co-infection were uncommon events in both eras. Alcohol abuse increased (14% vs 29%, p < .01) while injection drug abuse remained the same (5% vs 7%, p = .55) in the HAART era. Depression diagnoses also remained constant among ARL patients (45% vs 43%, p = .78). In summary, there are an increased proportion of women, heterosexuals, and people of color developing ARL in King County, WA, although the overall ARL incidence continues to decline. ARL appears to be developing in HIV patients with improved immunological status and decreased history of opportunistic illnesses. Their risk of dying has decreased, although selected comorbid conditions remain constant.
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