Prognostic Factors in Children and Adolescents with Lymphomas and Vertical Transmission of HIV in Rio de Janeiro, Brazil: A Multicentric Hospital-Based Survival Analysis Study

Abstract

Lymphomas related to HIV are generally aggressive and have a poor prognosis, despite the use of combined antiretroviral therapy (cART) and effective chemotherapy treatment. To determine survival and prognostic factors in children and adolescents living with HIV (CLWH) in Rio de Janeiro (RJ), Brazil, who developed lymphomas, we performed a retrospective and observational study of vertically infected CLWH aged from 0 to 20 incomplete years during1995 to 2018 at five reference centers for cancer and HIV/AIDS treatment. Of the 25 lymphomas, 19 were AIDS-defining malignancies (ADM) and 6 were non-AIDS-defining malignancies (NADM). The 5-year overall survival (OS) and 5-year event-free survival (EFS) probabilities were both 32.00% (95% CI = 13.72–50.23%), and the 5-year disease-free survival (DFS) probability was 53.30% (95% CI = 28.02–78.58%). In the multivariate Cox regression analysis, performance status 4 (PS 4) was considered a poor prognostic factor for OS (HR 4.85, 95% CI = 1.81–12.97, p = 0.002) and EFS (HR 4.95, 95% CI = 1.84–13.34, p = 0.002). For the DFS, higher CD4+ T-cell counts were considered a better prognostic factor (HR 0.86, 95% CI = 0.76–0.97, p = 0.017) in the multivariate Cox regression analysis. This study demonstrates, for the first time, survival and prognostic factors for CLWH who developed lymphomas in RJ, Brazil.

Gallbladder Burkitt’s Lymphoma in a Child Living with HIV: A Case Report

“…In this population, lymphomas are often detected at a late stage with the involvement of tissues outside the lymph nodes, and usually with a rapid and aggressive progression [22,23,25,34]. It is widely acknowledged that the presence of HIV infection significantly worsens the prognosis for children and adolescents with lymphoma, even with the use of antiretroviral therapy and chemotherapy [35][36][37][38][39][40][41].…”

“…In the context of immunosuppression due to HIV infection, ART/cART, in combination with chemotherapy, has the highest priority in BL treatment, even if higher than surgery [1,[40][41][42]46]. Unfortunately, the patient died from sepsis and disease progression about 18 months after the lymphoma diagnosis despite the early beginning of chemotherapy (around 20 days after surgery and histopathological analysis).…”

“…In reality, at this time (1999)(2000), antiretroviral therapy was not yet recommended in similar cases by Brazilian Ministry of Health guidelines [17]. In a recent work published by our research group, it was observed that patients who achieved complete remission, but did not recover CD4+ levels, had inferior survival rates with higher relapse occurrence and infections related to the rescue protocols instituted [41]. Nowadays, the role of antiretroviral therapy is well-established for a better prognosis of PLWH precisely because it prevents the appearance and recurrence of malignant tumors, especially lymphomas [10,22,[40][41][42]46].…”