AIDS-associated non-Hodgkin's lymphoma in the era of highly active antiretroviral therapy.
In populations receiving highly active antiretroviral therapy (HAART), the incidence of non-Hodgkin's lymphoma (NHL) has decreased by less than other AIDS-associated illnesses. In Australian AIDS-registration data, NHL has decreased by 37.5% since 1994, compared with a 55% decrease for other AIDS-associated illnesses (p = .033). Three factors may contribute to this discrepancy. First, in contrast to most other AIDS-associated illness, molecular and epidemiologic evidence suggests that there is no single organism that causes AIDS-related NHL. Thus, the HAART-induced partial recovery of reactivity to foreign antigens may be relatively ineffective in NHL prevention. Second, with the exception of primary NHL of the central nervous system, AIDS-related NHL tends to occur at a less advanced stage of immune deficiency than other AIDS-related diseases; therefore, the HAART-associated partial recovery of the immune system may be insufficient to prevent NHL. Third, it is unclear whether HAART is fully effective at reversing the B-cell stimulation that is associated with HIV infection and is a risk factor for NHL. Unless more complete immune reconstitution can be achieved, it is likely that NHL will become proportionately more important as a cause of morbidity and mortality in people with HIV and AIDS.
Grulich
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National Centre in HIV Epidemiology and Clinical Research, Sydney, New South Wales, Australia. agrulich@nchecr.unsw.edu.au
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D019380:Anti-HIV Agents / Q000008:administration & dosage; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D006801:Humans; D015994:Incidence; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology*; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology*
D019380:Anti-HIV Agents