NHL Often the Initial AIDS-Defining Illness

ORLANDO—A large percentage of HIV-infected patients present with non-Hodgkin’s lymphoma (NHL) as their initial AIDS-defining illness, according to a retrospective study in patients with HIV-related systemic NHL at one institution. Garrett R. Lynch, MD, reviewed the data at the American Society of Hematology (ASH) annual meeting (abstract 1434).

Dr. Lynch and his associates from Baylor College of Medicine, analyzed data they collected from Ben Taub General Hospital, Houston, from 1989 to 2000. "We analyzed retrospectively our experience with HIV patients with NHL. A total of 88 patients were identified," he said.

The mean age of the patients at time of disease presentation was 39 years; there were 77 men and 11 women. Stage III/IV disease was present in 77 patients, and systemic (B) symptoms in 72. There was extranodal involvement of at least one site in 77 patients, and 10 had involvement in at least three or more nodal sites.

Other significant sites of disease invasion included bone marrow in 29 patients (33%), central nervous system in 19 (20%), gastrointestinal tract in 15 (17%), and liver involvement in 20 (23%). The mean CD4 count was 203 cells/mm³ (range, 4 to 1,403). An important histologic finding: Diffuse large B cell lymphoma accounted for 66% of the cases; 17% of cases (15 patients) had the immunoblastic variant.

Dr. Lynch said that 18 patients (20%) did not get any treatment for their NHL because of poor performance status or because diagnosis was made at the time of autopsy.

HIV Status at Time of Diagnosis

"Interestingly, when we compared the known HIV-positive group with the new HIV-positive group, we found there was a trend toward older age in the known group, 41 years vs 38, respectively," Dr. Lynch said.

Other noteworthy comparisons between the two groups were:

• Risk for GI involvement was significantly higher in the known HIV-positive group.

• Small noncleaved cell lymphoma was significantly more common in the new HIV-positive group.

• Median survival was similar for both groups.

When comparing patients presenting between 1996 and 2000 with those presenting with disease between 1989 and 1995, the more recent cohort was more likely to be older, less likely to be white, and less likely to be homosexual. There was no change with time in the percentage of patients with new HIV diagnosis.

The median survival of the more recent group (1996-2000) was 29 weeks, compared with 22 weeks for the group diagnosed between 1989 and 1995.

Although some treatment aspects of HIV-related NHL have been enhanced over the past several years, this is still a very complex and challenging medical situation, Dr. Lynch said.

"The large proportion of our patients presenting with NHL as their first AIDS-defining illness suggests that aspects of immune dysregulation other than advanced immune suppression alone may play a significant role in the pathogenesis of lymphoma and, thus, be a determining factor in analyzing clinical features such as histology and sites of involvement," he said.

He believes it is important that future therapies for NHL in newly diagnosed HIV-infected patients "include aggressive treatments aimed at restoring the immune capacity."