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Blood, 15 October 2000, Vol. 96, No. 8, pp. 2730-2734
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Changes in acquired immunodeficiency syndrome-related lymphoma
since the introduction of highly active antiretroviral therapy
Gail V. Matthews,
Mark Bower,
Sundhiya Mandalia,
Tom Powles,
Mark R. Nelson, and
Brian G. Gazzard
From the Department of HIV Medicine and Department of
Oncology, Chelsea and Westminster Hospital, London, United Kingdom.
Clinical data on 7840 HIV-positive patients, representing 43 745
patient-years of follow-up, has been collected. All patients with ARL
since 1986 (n = 150) were assessed at presentation for prognostic
factors and outcomes recorded. Comparisons are made between cases in
the pre-HAART era (1988-1995), and the HAART era (1996-1999).
Statistical models are used to calculate the incidence of ARL and
factors predicting its development. The incidence of ARL has not
changed over time (3 to 7 of 1000 patients per year,
P = .933), but contributes to a greater percentage of
first AIDS-defining illnesses (ADI) in the HAART era
(P  .0001). Older age, nadir CD4 count, and no prior
HAART use, predict the development of ARL. There has been no change in
stage at presentation, presence of B symptoms, performance status, or
marrow involvement between the 2 time cohorts or between patients with
or without prior HAART exposure. Similarly, there is no difference in
survival duration between the pre-HAART and HAART era (log rank
P = .15) or specifically in patients treated with HAART
before ARL diagnosis (log rank P = .12). The use of HAART
has not yet been shown to influence the incidence or survival of ARL.
However, because nadir CD4 count and use of HAART are independent
predictors of ARL development, this may translate into a future fall in
new cases.
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