Title:HIV-Related Lymphoproliferative Diseases in the Era of Combination Antiretroviral Therapy
Volume: 20
Issue: 3
Author(s): Roberto Castelli*, Riccardo Schiavon, Carlo Preti and Laurenzia Ferraris
Affiliation:
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan,Italy
Keywords:
Human immunodeficiency virus (HIV) lymphomas, diffuse large B-cell lymphoma (DLBCL), central nervous
system lymphomas (PCNSL), burkitt lymphoma (BL), primary effusion lymphoma (PEL), plasmablastic lymphoma (PL),
hodgkin lymphoma (HL), combination antiretroviral therapy (CART).
Abstract: HIV-positive patients have a 60- to 200-fold increased incidence of Non-Hodgkin
Lymphomas (NHL) because of their impaired cellular immunity. Some NHL are considered
Acquired Immunodeficiency Syndrome (AIDS) defining conditions. Diffuse large B-cell Lymphoma
(DLBC) and Burkitt Lymphoma (BL) are the most commonly observed, whereas Primary Effusion
Lymphoma (PEL), Central Nervous System Lymphomas (PCNSL), Plasmablastic Lymphoma (PBL)
and classic Hodgkin Lymphoma (HL) are far less frequent. Multicentric Castleman disease (MCD)
is an aggressive lymphoproliferative disorder highly prevalent in HIV-positive patients and strongly
associated with HHV-8 virus infection. In the pre-Combination Antiretroviral Therapy (CART) era,
patients with HIV-associated lymphoma had poor outcomes with median survival of 5 to 6 months.
By improving the immunological status, CART extended the therapeutic options for HIV positive
patients with lymphomas, allowing them to tolerate standard chemotherapies regimen with similar
outcomes to those of the general population. The combination of CART and chemotherapy/
immuno-chemotherapy treatment has resulted in a remarkable prolongation of survival among HIVinfected
patients with lymphomas. In this short communication, we briefly review the problems
linked with the treatment of lymphoproliferative diseases in HIV patients. Combination
Antiretroviral Therapy (CART) not only reduces HIV replication and restores the immunological
status improving immune function of the HIV-related lymphomas patients but allows patients to
deal with standard doses of chemotherapies. The association of CART and chemotherapy allowed
to obtain better results in terms of overall survival and complete responses. In the setting of HIVassociated
lymphomas, many issues remain open and their treatment is complicated by the patient’s
immunocompromised status and the need to treat HIV concurrently.
