Changes in acquired immunodeficiency syndrome‐related non‐Hodgkin lymphoma in the era of highly active antiretroviral therapy

Abstract

BACKGROUNDThe authors sought to determine whether the availability of highly active antiretroviral therapy (HAART) coincided with changes in the epidemiology of acquired immunodeficiency syndrome (AIDS)‐related non‐Hodgkin lymphoma (NHL).METHODSCancer registry data from 1988–2000 were linked with AIDS registry data from 1981 to July 2003 for San Diego County to identify 537 AIDS‐NHL patients. By using the total number of patients with AIDS who were alive as of July 1 annually as the AIDS population denominator, the average annual incidence of NHL was estimated among patients with AIDS for the pre‐HAART period (1988–1995) and post‐HAART period (1996–2000). The chi‐square test was used to compare proportions, and a Cox proportional hazards model was used to compare survival between the pre‐HAART and post‐HAART periods.RESULTSThe incidence of NHL decreased from 29.6 per 1000 person‐years pre‐HAART to 6.5 per 1000 person‐years post‐HAART. The proportion of patients who had NHL of central nervous system (CNS) origin decreased from 28% pre‐HAART to 17% post‐HAART. Among patients with systemic NHL, 54% received chemotherapy pre‐HAART, and 72% received chemotherapy post‐HAART. The percentage of intermediate‐grade NHL increased from 33% pre‐HAART to 49% post‐HAART, and the percentage of high‐grade NHL decreased from 38% to 19%, respectively. A diagnosis of human immunodeficiency virus infection preceding the NHL diagnosis and Stage IV NHL were associated with worse survival, whereas a diagnosis of NHL in the post‐HAART period and chemotherapy were associated with better survival. The median survival was 4 months pre‐HAART and 9 months post‐HAART.CONCLUSIONSSince the introduction of HAART, there has been a decrease in the incidence of systemic and CNS NHL among patients with AIDS. Among patients with systemic, AIDS‐related NHL, there has been decreased high‐grade histology, increased use of chemotherapy, and improved survival. Cancer 2006. © 2005 American Cancer Society.

Trends in the incidence of cancer in the black population of Harare, Zimbabwe 1991–2010

“…This may also be associated with increasing access to ART-in the USA, there has been a decrease in the incidence of systemic and CNS NHL among patients with AIDS following the introduction of ART. 27 …”

Activation of mTORC1 Signaling Pathway in AIDS-Related Lymphomas

“…Other histological types such as Burkitt lymphoma (BL), Hodgkin lymphoma, and T/null cell anaplastic large cell lymphoma are also overrepresented among ARLs. [1][2][3][4] The pathogenesis of ARL is poorly understood. It has been postulated that cell proliferation occurring in the setting of severe immunosuppression and driven by chronic antigenemia resulting at first in the polyclonal and ultimately in the monoclonal lymphoproliferation plays a key role in lymphomagenesis in HIV patients.…”

“…In addition, cell infection by the EpsteinBarr virus (EBV) and human herpesvirus 8 (HHV8) most likely contributes to the malignant cell phenotype in some subtypes of ARL, with the association of primary effusion lymphoma with HHV8 being essentially universal. [1][2][3][4] Regardless of the histological type of ARL, chemotherapy is typically ineffective and new treatment approaches are clearly needed to combat this group of lymphomas. In addition to ARL, HIV patients develop a benign reactive lymphadenopathy, particularly early after the infection as an overall ineffective response to the virus.…”

Decrease in the frequency of meningeal involvement in AIDS-related systemic lymphoma in patients receiving HAART

“…[4][5][6] The prognosis of AIDS-related lymphomas (ARL) has improved since the introduction of HAART. [4][5][6][7][8][9] However, to our knowledge, there are no studies regarding the impact of HAART on the frequency of CNS involvement in systemic ARL. The aim of this study was to analyze whether the prevalence of CNS involvement in AIDS-related NHL has changed in patients receiving HAART.…”

“…After the introduction of HAART, a decline was observed in PCL. 5,6 Since PCL typically occurs in severely immunosuppressed patients with low CD4 counts, the increase in these lymphocytes produced by HAART is widely thought to be directly responsible for the fall in the incidence of PCL in the HAART era. In our series, patients without HAART had lower CD4 lymphocyte counts and a higher HIV load than those on HAART, supporting the hypothesis that these parameters could play a role in CNS involvement in ARL.…”