CHICAGOHighly active anti-retroviral therapy (HAART) has drastically
reduced the incidence of primary central nervous system (CNS) lymphoma in
HIV-positive individuals at a French hospital and improved survival in
HIV-positive patients who have the brain malignancy.
A poster presented at the Interscience Conference on Antimicrobial Agents
and Chemotherapy (ICAAC abstract 250) traced patients with primary CNS lymphoma
over a 17-year period.
Only eight cases of the disease have occurred since HAART was introduced in
1996, said Phillippe Bossi, MD, of Pitie-Salpetriere Hospital. Median survival,
which was only 1 month prior to the introduction of HAART, increased to 10
months between 1996 and 1999, he said.
The poster presented findings from a retrospective analysis of 80 patients
with primary CNS lymphoma out of a total of 2,263 individuals with AIDS who
were followed from 1983 to 1999 at Pitie-Salpetriere Hospital. Between 1988 and
1991, the incidence of primary CNS lymphoma rose steadily, reaching a peak of
39 per 1,000 patient-years. The incidence has declined since 1991, dropping to
1.9 per 1,000 patient-years in 1999.
In 29 patients (36%), primary CNS lymphoma was the first indication of AIDS.
The vast majority of patients were male (92%). A total of 66 patients (82%)
Median survival increased in particular for patients who had high CD4+ cell
counts at the time primary CNS lymphoma was diagnosed. Of the 8 patients
diagnosed since 1996, four lived less than 5 months after diagnosis. These
patients had CD4+ cell counts ranging from 1 to 4/µL at diagnosis, and the count did not change from diagnosis to death.
In contrast, the other four patients, with median CD4+ cell counts of
95/µL, lived longer than 15 months, and their cell counts had increased to
241/µL at the time of their death or the last measurement. Two of these
patients were still alive 38 and 44 months after diagnosis and use of HAART.