Parameters affecting the development of non-Hodgkin's lymphoma in patients with severe human immunodeficiency virus infection receiving antiretroviral therapy.
OBJECTIVE
To investigate the occurrence of non-Hodgkin's lymphoma (NHL) in human immunodeficiency virus (HIV)-infected patients receiving long-term antiretroviral therapy and factors associated with the development of these lymphomas.


METHODS
The charts of 55 patients with advanced HIV infection receiving zidovudine (formerly known as azidothymidine [AZT])-based therapy and 61 patients receiving dideoxyinosine (ddI) were examined for the occurrence of NHL. Stored samples from the AZT-based treatment cohort were examined retrospectively for parameters predictive of the subsequent development of lymphoma.


RESULTS
Eight of 55 patients receiving AZT-based therapy developed NHL, yielding an estimated probability of 12% (95% confidence interval [CI], 4.7% to 27.1%) after 24 months, and 29.2% (95% CI, 15.2% to 48.7%) after 36 months. Four of 61 patients receiving ddI developed NHL, yielding a 6.2% (95% CI, 2.1% to 17%) estimated probability after 24 months, and 9.5% (95% CI, 3.6% to 22.8%) after 36 months. The difference between these cohorts was not significant (two-tailed P [P2] = .13). Patients with less than 50 CD4 cells/microL developed NHL at a significantly higher rate (P2 = .0085). This was particularly true for patients who presented with primary CNS lymphoma (PCNSL). For patients receiving AZT-based therapy, pretreatment serum interleukin-6 (IL-6) levels were somewhat higher in those who subsequently developed NHL than in those who did not (P2 = .048).


CONCLUSIONS
HIV-infected patients with profound immunodeficiency, especially those with less than 50 CD4 cells/microL, are at substantial risk of developing NHL and particularly PCNSL. Additional studies are needed to define the role of other factors such as IL-6 in the pathogenesis of these opportunistic tumors.
Pluda
J M
JM
Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
Venzon
D J
DJ
Tosato
G
G
Lietzau
J
J
Wyvill
K
K
Nelson
D L
DL
Jaffe
E S
ES
Karp
J E
JE
Broder
S
S
Yarchoan
R
R
D015496:CD4-Positive T-Lymphocytes; D016049:Didanosine / Q000009:adverse effects / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D016483:Lymphoma, AIDS-Related / Q000276:immunology; D008228:Lymphoma, Non-Hodgkin / Q000209:etiology*; D012307:Risk Factors; D015215:Zidovudine / Q000009:adverse effects / Q000627:therapeutic use*
D015850:Interleukin-6; D015215:Zidovudine; D016049:Didanosine