Implications of the Shifting Pathobiology of AIDS-Related Lymphoma

Extract

The advent of antiretroviral therapy (ART) led to substantial improvements in the outcome for patients with HIV-associated lymphoma ( 1–5 ). Whereas a diagnosis of aggressive lymphoma in the setting of HIV was a likely fatal complication in the pre-ART era, this was no longer the case after the widespread institution of ART because of improved HIV control, reduced opportunistic infections, and improved lymphoma treatment. Presently, most patients with HIV-associated diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), and Hodgkin lymphoma (HL) can be cured of their disease with optimal treatment ( 3 , 4 , 6 , 7 ).

In this edition of the Journal, Gopal and colleagues examine a cohort of more than 23000 HIV-positive patients from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) ( 8 ). They provide insights into temporal changes in presentation and outcome of patients with a diagnosis of lymphoma in the United States since the start of the antiretroviral era. The study presents several interesting findings. Over the 14-year duration studied, which the authors divided into three time periods, the age at diagnosis of HIV-associated lymphoma steadily increased and the proportion of patients with nonwhite, nonblack ethnicity rose, reflecting the shifting demographics of the epidemic. In addition, over these time periods, patients were less immune-compromised, as measured by CD4 lymphocyte count and HIV loads.