Changes in acquired immunodeficiency syndrome–related lymphoma since the introduction of highly active antiretroviral therapy

Abstract

Clinical data on 7840 HIV-positive patients, representing 43 745 patient-years of follow-up, has been collected. All patients with ARL since 1986 (n = 150) were assessed at presentation for prognostic factors and outcomes recorded. Comparisons are made between cases in the pre-HAART era (1988-1995), and the HAART era (1996-1999). Statistical models are used to calculate the incidence of ARL and factors predicting its development. The incidence of ARL has not changed over time (3 to 7 of 1000 patients per year,P = .933), but contributes to a greater percentage of first AIDS-defining illnesses (ADI) in the HAART era (P ≤ .0001). Older age, nadir CD4 count, and no prior HAART use, predict the development of ARL. There has been no change in stage at presentation, presence of B symptoms, performance status, or marrow involvement between the 2 time cohorts or between patients with or without prior HAART exposure. Similarly, there is no difference in survival duration between the pre-HAART and HAART era (log rankP = .15) or specifically in patients treated with HAART before ARL diagnosis (log rank P = .12). The use of HAART has not yet been shown to influence the incidence or survival of ARL. However, because nadir CD4 count and use of HAART are independent predictors of ARL development, this may translate into a future fall in new cases.

Progression of HIV infection in the post‐HAART era among a cohort of HIV+ Greek haemophilia patients

“…Early reports in the post-HAART era have suggested stable or even increased rates of NHL [20][21][22]. However, more recent reports from large and welldefined seroconvertersÕ cohorts have shown a clear decline in the NHL incidence [18,23,24].…”

Modern management of non‐Hodgkin lymphoma in HIV‐infected patients

“…Different chemotherapy regimens have been tested in ARL patients (Gisselbrecht et al , 1993; Kaplan et al , 1997; Little et al , 2003; Costello et al , 2004; Sparano et al , 2004) but there is still disagreement regarding the optimal treatment, even in the post‐HAART era. Overall improvement was observed by some investigators (Besson et al , 2001; Gerard et al , 2002) but not others (Matthews et al , 2000; Noy, 2004). The four‐drug CHOP regimen (cyclophosphamide, adriamycin, vincristine and prednisone) seems to confer some benefit with regard to the duration of remission, and to improve the results of the standard treatments for HIV‐negative patients with high‐grade NHL (Fisher et al , 1993).…”

Characteristics of indolent non‐hodgkin lymphoma in patients with type 1 human immunodeficiency virus infection

“…Overall, approximately 3% of AIDS patients present with NHL,8 although as many as 16–20% eventually die of the disease 9. Although a recent international collaborative study has shown a statistically significant decline in AIDS‐related lymphoma (ARL), coincident with the widespread use of highly active antiretroviral therapy,10 other studies have shown no such statistically significant decrease 11, 12. Furthermore, ARL now has become more common than some of the opportunistic infections as an initial AIDS‐defining diagnosis 12…”