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hrsa

participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



HIV-Associated Non-Hodgkin's Lymphoma: Incidence, Presentation, and Prognosis [Little RF, et al. JAMA 2001;285:1880]: This is a review of non-Hodgkin's lymphoma from the NCI. The following are the salient features:

  • Frequency: Increased 60-fold with HIV; no difference by risk category.
  • Frequency as AIDS-defining condition: 3%.
  • Clinical presentation: Usually presents as a mass lesion that is growing rapidly and/or the development of "B" symptoms (night sweats, weight loss), and evidence of extranodal involvement: bone marrow (20 - 40%), GI tract (26%), and CNS (17 - 32%).
  • Median survival: With CD4 count <100/mm3 - four months; with CD4 count >100/mm3 - 11 months.
  • Major categories: 1) Burkitt's lymphoma; 2) B-cell immunoblastic lymphoma; and 3) Primary effusion lymphoma.
  • Management of NHL: Chemotherapeutic regimens pursued at the NCI include etoposide, vincristine, and doxorubicin as continuous 96-hour infusions with bolus of cyclophosphamide and prednisone.
  • HAART: This concurrent use is complicated by overlapping toxicities, primarily GI intolerance. Cyclophosphamide is excreted by the CYP450 system. One option is to withhold HAART until the completion of chemotherapy. A second option is to continue or initiate HAART with close follow-up on drug tolerance. A third option is to modify HAART to the regimen that has the least overlapping toxicity and drug-drug interactions.
posted 5/3/2001




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