AIDS and Non-Hodgkin's lymphoma. Experience at an oncological center in Mexico

Background. Non-Hodgkin lymphoma (NHL) associated with HIV became an AIDS-defining condition early in the epidemic and remains the second most common malignancy in patients with AIDS. With the advent of highly active antiretroviral therapy (HAART), the incidence and mortality of AIDSrelated opportunistic infections and Kaposi’s sarcoma has fallen dramatically, this trend is not observed so clearly for NHL. Our objective was to review the clinical spectrum of patients with AIDS-associated NHL and to analyze the impact of HAART on survival at an oncological tertiary center. Material and methods. We reviewed all medical records and histopathologic tissue of patients with HIV-associated NHL seen from January 1990 to September 2007 at the Instituto Nacional de Cancerologia in Mexico City. Survival or follow-up time was calculated from date of diagnosis to death, or to the date on which the patient was last seen. Results. Eighty seven HIV-positive patients were diagnosed with NHL (diffuse large B-cell lymphoma n = 69; Burkitt-like n = 8; pleomorphic large cell n = 7; low-grade n = 2, and angiocentric n = 1). Twenty eight patients never received HAART, and 59 received HAART. Overall, 38 patients (43.7%) achieved complete response to NHL therapy, including only 14.3% patients in the non-HAART compared with 57.6% in the HAART group (p = 0.0001). Two patients (7.1%) in the non-HAART were alive compared with 37 (63.8%) in the HAART group (p ≤ 0.0001). Mean survival time for all patients was 11 ± 16.8 months. Survival was significantly shorter in patients not receiving HAART (4.8 ± 7.6 months) as compared with those who did (14 ± 19.2) (p = 0.01). Conclusions. Patients with NHLHIV who were able to receive treatment with HAART and were sufficiently healthy to receive optimal chemotherapy treatment showed a significantly better prognosis.