HAART positively affects survival of AIDS-related non-Hodgkins lymphoma

Edwin J. Bernard
Estimated reading time 2 minutes
This article is more than 21 years old.

Response to HAART appears to be a very important factor when it comes to doing well with non-Hodgkin lymphoma (NHL), according to a German study published in the latest issue of AIDS, adding to the body of evidence that suggests that although NHL is appearing more often in the post-HAART era, HAART can still positively affect outcome.

Overall, non-Hodgkin lymphoma diagnoses have risen sharply in the post-HAART era. Almost 16% of all AIDS-defining illnesses seen in the EuroSIDA cohort in 1998 were NHL, and last year, when the Chelsea & Westminster’s Kobler Centre reviewed the cause of death of the last 100 patients to die of AIDS-related illnesses, 13 died of NHL compared with three in the pre-HAART era. Additionally, it has been found that in comparison with the general population the risk for non-Hodgkin lymphoma is 100 to 400 times higher in people with HIV.

Investigators in Germany analysed 203 HIV-infected patients diagnosed with non-Hodgkin lymphoma between January 1990 and December 2001, looking at their use of and response to HAART which they defined as either an increase of more than 100 CD4 cells/mm3 or at least one viral load measurement below 500 copies/mL, or both.

Glossary

non-Hodgkin lymphoma

A group of lymphomas (cancers of the lymphatic system). The many types of non-Hodgkin lymphoma (NHL) are classified according to how fast the cancer spreads. Although the symptoms of NHLs vary, they often include swollen lymph nodes, fever, and weight loss. Certain types of NHLs, such as Burkitt lymphoma and immunoblastic lymphoma, are AIDS-defining cancers in people with HIV.

remission

The disappearance of signs and symptoms of a disease, usually in response to treatment. The term is often used in relation to cancer, indicating that there is no evidence of disease, although the possibility of cancer remaining in the body cannot be ruled out. In HIV, remission is an alternative term for ‘functional cure’. A sustained ART-free remission would boost the immune system to induce long-term control of HIV, allowing a person living with HIV to maintain an undetectable viral load without daily medication.

lymphoma

A type of cancer that starts in the tissues of the lymphatic system, including the lymph nodes, spleen, and bone marrow. In people who have HIV, certain lymphomas, such as Burkitt lymphoma, are AIDS-defining conditions.

Hodgkin disease

A type of lymphoma. Lymphoma is a cancer of a part of the immune system called the lymph system. The first sign of Hodgkin disease is often an enlarged lymph node. The disease can spread to nearby lymph nodes, the lungs, liver, or bone marrow. The exact cause is unknown. See also non-Hodgkin lymphoma.

chemotherapy

The use of drugs to treat an illness, especially cancer.

Between 1997 and 2001, 71% received HAART during the first two years of their NHL diagnosis, and 78% received chemotherapy, usually CHOP. Those receiving chemotherapy and HAART were significantly more likely to achieve complete remission (71% vs. 48%; p = 0.006). This compares with an overall complete remission rate of 57%, which is similar to rates seen in other cohorts (43-67%). Although it could be argued that those who achieved complete remission were more likely to be well enough to tolerate HAART, the investigators also found that response to HAART was an independent predictor for prolonged survival even adjusting for complete remission (Relative Hazard 0.32; p = 0.0008).

Although the average time of survival from diagnosis to death was only 9 months in the total cohort, 83% of those who achieved both a complete remission and responded to HAART were still alive after 39 months.

The authors found that the traditional factors previously associated with doing poorly with NHL are changing in the HAART era, and that whilst a prior AIDS diagnosis and extranodal involvement (spread of cancer outside of the lymph nodes) were still associated with poor outcome, “response to chemotherapy and response to HAART were independently associated with improved survival.”

Further information on this website

Non-Hodgkin lymphoma

References

Hoffmann C et al. Response to highly active antiretroviral therapy strongly predicts outcome in patients with AIDS-related lymphoma. AIDS; 17(10):1521-1529, 2003.

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