Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy

Abstract

HIV infection is associated with a high incidence of AIDS-related lymphomas (ARLs). Since the use of highly active antiretroviral therapy (HAART), the incidence of AIDS-defining illnesses has decreased, leading to a significant improvement in survival of HIV-infected patients. The consequences of HAART use on ARL are under debate. This study compared the incidence and the characteristics of ARL before and after the use of HAART in a large population of HIV-infected patients in the French Hospital Database on HIV (FHDH) and particularly in 3 centers including 145 patients with proven lymphoma. Within the FHDH, the incidence of systemic ARL has decreased between 1993-1994 and 1997-1998, from 86.0 per 10 000 to 42.9 per 10 000 person-years (P < 10 ؊30 ). The incidence of primary brain lymphoma has also fallen dramatically between the periods, from 27.8 per 10 000 to 9.7 per 10 000 person-years (P < 10 ؊11 ). The analysis of 145 cases of ARL in 3 hospitals showed that known HIV history was longer in the second period than in the first period among patients with systemic ARL (98 versus 75 months; P < .01).Patients had a higher number of CD4 cells at diagnosis during the second period (191 versus 63/L, P ‫؍‬ 10 ؊3 ). Survival of patients with systemic ARL also increased between the periods (from 6 to 20 months; P ‫؍‬ .004). Therefore, the profile of ARL has changed since the era of HAART, with a lower incidence of systemic and brain ARL.

Kaposi's Sarcoma Biology

“…This suggests that cellular immune responses, compromised in AIDS, but recovering after HAART, could be important in the control of KSHV infection and in the development of KS. This is further supported by the observation that posttransplant KS lesions regress when immunosuppressive treatment is stopped (14)(15)(16)(17).…”

AIDS and non-AIDS diffuse large B-cell lymphomas express different antigen profiles

“…[20][21][22] With the advent of highly active antiretroviral therapy, the incidence of AIDSrelated non-Hodgkin's lymphomas has declined. [23][24][25] A meta-analysis of 23 cohort studies (involving 47 936 seropositive individuals) showed reduced incidence rates from 1992-1996 (6.2 per 1000 person-years) to 1997-1999 (3.6 per 1000 personyears). 23 Part of this reduction may be due to improved CD4 cell counts.…”

“…24 Despite the three-fold increase in survival of patients with AIDS-related lymphomas, the prognosis still appears worse than HIV-negative patients with comparable disease. 24,26,27 It is unclear whether these differences between AIDS-related and non-AIDS diffuse large B-cell lymphomas reflect biological variations in the lymphoma itself, or in the immunodeficient host, or in both. A definitive understanding of the pathogenesis of AIDS-related diffuse large B-cell lymphomas is still lacking.…”

Hepatitis C infection is not associated with systemic HIV‐associated non‐hodgkin's lymphoma: A cohort study

“…2 NHL occurs at a greatly increased frequency in HIV-infected populations and despite a reduction in its incidence during the HAART era, it remains the second commonest AIDS defining malignancy after Kaposi's sarcoma. [3][4][5][6][7] Many of the 200 million individuals infected with HCV and the 50 million individuals infected with HIV are co-infected with both viruses. [8][9][10] As well as shared routes of transmission, there are many interactions between these small RNA viruses in which infection is often characterised by parenteral transmission followed by a seroconversion illness and then a long latent period lasting many years.…”