Linfomas asociados a infección por Virus de Inmunodeficiencia Humana: Experiencia de un centro hospitalario de la V región, Chile / Lymphomas associated with human immunodeficiency virus infection: Retrospective review of medical records

Background: The incidence oflymphoma increases enormously inpatients infecten with the human immunodeficiency virus (HIV). Aim: To describe the incidence, clinical and histológica! characteristics, treatments and survival of lymphomas associated with HTV infection. Material and Methods: Retrospective review of medical records ofpatients with HIV and lymphoma, treated in a public hospital, between January 2001 and June 2009. Results: Twenty-two mole patients were included but 14 had immunohistochemical confirmation ofthe lymphoma. The accumulated incidence for thisperiod was 2.8 percent. The median age at lymphoma diagnosis was 39.5 years. Twelvepatients (86 percent) had non-Hodgkin lymphoma (NHI) and two (14 percent) Hodgkin lymphoma. The main pathological type of non-Hodgkin lymphomas was diffuse large B cell in seven cases (50 percent). The mean CD4 cell count and viral load were 83 cell/mm³ (33.5-113.5) and 26.000 RNA copies/ml (1210-196500), respectively Twelve patients (86 percent) had B type symptoms of lymphoma at the moment of diagnosis. Eleven patients (29 percent) received chemotherapy with or without radiotherapy, onepatient (7 percent) received radiotherapy alone and two patients (14 percent) received palliative symptomatic treatment. Six cases (43 percent) received highly active antiretroviral therapy simultaneously with chemotherapy. Global mortality in this series was 57 percent (8patients) with a median survival time of 5.8 months (2.6-26.2). Conclusions: In this series ofpatients infected with HIV, a predominance of aggressive histológica! subtypes of lymphomas and low complete remission rates, were observed.

AIDS-related lymphomas in Nigeria

Aggressive non-Hodgkin's lymphoma (NHL), including primary central nervous system (CNS) lymphoma, lymphoblastic lymphoma and non-endemic Burkitt's lymphoma have been recognized as AIDS-defining cancers in most developed countries. However, HIV/AIDS epidemics appear not to have been associated with higher incidence of lymphomas in Africa. We therefore carried out this study to highlight the significance or otherwise of HIV/AIDS epidemics in the pathogenesis of lymphomas in a population of Nigerians with the disease. Since January 1993 to the present, all patients with haematologic cancers are routinely screened (following appropriate counseling) for HIV infection. Patients with a histological diagnosis of malignant chronic lymphoproliferative diseases {non-Hodgkin lymphoma (NHL), chronic lymphocytic leukaemia (CLL), Burkitt's lymphoma (BL) and Hodgkin lymphoma (HL)} at the Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife from January 1993 to August 2008 were noted. Those patients confirmed to be HIV/AIDS positive among the cohort with lymphomas were retrospectively studied using their clinical case notes. Data obtained were analyzed using appropriate descriptive and inferential statistics. A total of 391 patients were histologically confirmed to have lymphoma {NHL-109, (27.9 percent); CLL-76, (19.4 percent); BL-178, (45.5 percent) and HL-28, (7.2 percent)} during the study period. Nine patients (2.3 percent) were confirmed to be HIV- positive, all within the age bracket 24-60 (median = 50) years. Six of these, five males and one female, ages 24-60 (median = 37.5) years, had NHL while another three, all females (age 50 - 68years; median = 56 years) had CLL. None of the patients with HL and BL were HIV positive. Patients with NHL presented at advanced stage of the disease (at least clinical stage IIIb), and all those with CLL presented at stage C of the International Working Party Classification. All the HIV-positive patients ...

Linfomas asociados a infección por virus de inmunodeficiencia humana en un complejo hospitalario de la Región Metropolitana, Chile: 1990-2002. Reporte de 14 casos y revisión / Lymphomas and HIV infection in a reference hospital of Santiago, Chile: 1990-2002: Report of 14 cases and review

The association of HIV infection and lymphoma in patients attending at the South Health Metropolitan Reference Centre is presented. Objective: to analyse its incidence, clinical and pathologic manifestations, treatment and outcome. Period of study: January 1990 to December 2002. Results: 14 cases were detected, 10 non Hodgkin lymphoma patients (7 with high malignancy and 50 percent in stages III-IVB) and 4 with Hodgkin lymphoma (3 with mixed cellularity, 2 in stage IVB). The annual incidence was 0.68 percent. Ten patients were classified under stage C3 of AIDS CDC criteria, the mean CD4 count was 139 cells/mm³ and mean CV was 5,32 log. Eighty six percent of patients presented with unique or multiples lymphonodes, with predominance of advanced lymphoma stage. Conventional CHOP chemotherapy was the treatment for high risk and extended non Hodgkin lymphomas and for extended Hodgkin lymphomas the ABVD protocol was administered. Six patients received antiretroviral therapy, 4 simultaneously with chemotherapy. Global mortality in this series was 71 percent, attributable to tumor disease per se or to sepsis. Four patients survived (18 to 50 months) in complete remission, 2 non Hodgkin lymphomas and 2 Hodgkin lymphomas. The low incidence of lymphoma and AIDS association and the high frequency of lymphomas with localized or generalized lymphonodes in this series are remarkable.

Se revisó la asociación de linfoma e infección por VIH en un complejo hospitalario de la Región Metropolitana Sur de Santiago de Chile, su incidencia, características clínicas y patológicas, terapia y evolución en 14 casos. La incidencia acumulada (enero 1990 y diciembre 2002) fue de 0,68 por ciento. Diez pacientes tenían linfoma no Hodgkin (siete de alto grado de malignidad y 50 por ciento en estadios III-IVB) y cuatro Hodgkin (tres con celularidad mixta, dos en estadio IVB). Diez pacientes con linfoma estaban en etapa C3 de SIDA según criterios del CDC, con un promedio de CD4 de 139 células/mm³ y carga viral de 212.600 copias de ARN/ml. Ochenta y seis por ciento tenía afección ganglionar, localizada o generalizada. El tratamiento de los linfomas no Hodgkin de alto grado y extendidos fue con quimioterapia CHOP convencional, y en los linfomas de Hodgkin avanzados se aplicó el esquema ABVD. Seis pacientes recibieron tratamiento antiretroviral, cuatro simultáneamente con quimioterapia. La mortalidad global fue de 71 por ciento, por progresión tumoral y/o sepsis. Cuatro pacientes sobreviven (18 a 50 meses) en remisión completa, dos linfomas no Hodgkin y dos Hodgkin. Se discuten la baja incidencia de la asociación linfoma y SIDA y la mayor frecuencia de linfomas con adenopatías localizadas o generalizadas.

Cancer and AIDS.

The occurrence of cancer as an AIDS defined disease is a subject that has received scant attention in the Indian medical establishments and lay public. It is important to know that the concept of acquired immunodeficiency syndrome was ushered in with reports of rare forms of cancers in HIV infected subjects. In the developed countries 34% of AIDS patients suffer from cancer, a cancer that is very aggressive, resistant to treatment and often fatal. On the other hand, incidence of cancer in patients infected with HIV virus is only 3%-4% in the Indian population. Nearly all patients with AIDS in India are victims of tuberculosis and opportunistic infections. Among the various cancers reported in the Indian population Kaposi's sarcoma is very rare indeed. AIDS associated malignant tumours tend to be more anaplastic and disseminate fairly early. The object of this review is to increase awareness of the various aspects of cancer and AIDS. There is an urgent need to improve gathering of epidemiological data and to direct research effort to explain a very strikingly low incidence of cancers in Indian subjects as compared to that in the West (prevalence of 4% versus 34% among HIV infected patients).

Linfomas no-Hodgkin asociados a SIDA: 1. Evolución durante los 20 años de la pandemia. 2. Experiencia en el INCMNSZ / Acquired inmunodeficiency syndrome-related lymphoma: 1.Evolution during the 20 years of the epidemic. 2. The experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: 1986-2003

El objetivo de esta revisión es situar la evolución epidemiológica y la historia natural de los linfomas no-Hodgkin (LNH) asociados a síndrome de inmunodeficiencia humana adquirida (SIDA) dentro del contexto de la evolución de la pandemia originada por la infección del virus de la inmunodeficiencia humana (VIH). Inicialmente realizamos una descripción del panorama mundial desde la aparición del primer caso de infección por VIH en 1981, el pico de la epidemia en 1993 y el evento que cambió la historia natural de la enfermedad: la terapia antirretroviral altamente efectiva (TARAE), introducida en 1995 en el mundo y en 1997 en nuestro país. Presentamos evidencia clara de la disminución en la mortalidad de pacientes con infección por VIH/SIDA y su relación paralela con la reducción en la frecuencia de las tres infecciones oportunistas (neumonía por Pneumocystis carinii, enfermedad por el complejo Mycobacterium avium y retinitis por citomegalovirus) más frecuentes en esta enfermedad. Describimos los factores de riesgo para padecer LNH en pacientes con VIH/SIDA y los factores pronósticos de supervivencia y remisión en estos pacientes. Señalamos también que se ha incrementado proporcionalmente el diagnóstico de SIDA definido por la presencia de LNH a partir del uso de TARAE. No está claramente definido en la literatura que la supervivencia de los pacientes con LNH asociados a SIDA haya cambiado significativamente a partir del uso de TARAE, pero existen evidencias que sugieren que la cuenta basal de linfocitos CD4 se ha visto incrementada con TARAE, redundando esto en una mejoría en la tasa de remisiones completas y supervivencia de los pacientes con LNH asociados a SIDA. La falta de congruencia en la literatura a este respecto posiblemente esté matizada por factores como apego a terapia antirretroviral, surgimiento de resistencia a la misma y heterogeneidad en los tratamientos de quimioterapia que han recibido estos pacientes. Existen muchas controversias en cuanto al tipo de quimioterapia que deben recibir los pacientes con LNH asociados a SIDA de reciente diagnóstico, que van desde la reducción o no de las dosis estándar de quimioterapia, la combinación temporal de ésta con TARAE, el uso de inmunoterapia conjuntamente con TARAEy quimioterapia. Finalmente, presentamos los resultados preliminares del análisis de la experiencia de nuestra Institución en LNH asociados a SIDA desde 1986 hasta diciembre del 2003.

The goal of this presentation is the description of the epidemiologic evolution and changes in natural history of the human immunodeficiency virus infection (HIV) epidemic itself and its relation with the acquired immunodeficiency syndrome-related lymphoma (ARL). We have started with the description of the world's state of the HIV epidemic, its features since the first case report in the United States of America in 1981, through the peak of new diagnoses in 1993 until the event that changed the natural history of the disease: the era of the widespread use of the highly active antiretroviral therapy (HAART), introduced in 1995 in the world and in 1997 in our country. The widespread introduction of HAART led to dramatic reductions in AIDS related mortality and morbidity throughout the developed world with a marked fall in the incidence of the major opportunistic infections in AIDS. We describe the main risk factors for the development of ARL, and the prognostic factors for survival and response to treatment. There is no clear definition in the literature of the roll that has played the use of HAART in relation to survival and response to treatment in ARL, but there is evidence that the basal count of CD4 cells has increased with HAART, leading to a better survival and response in ARL. The debate regarding this issue is surely affected by factors such as degree of antiretroviral treatment compliance, antiretroviral therapy resistance and chemotherapy heterogeneity. Finally we present the preliminary results of the analysis of our experience in ARL from 1986 to 2003.