Response to HAART appears to be a very important factor when it comes to doing well with non-Hodgkin lymphoma (NHL), according to a German study published in the latest issue of AIDS, adding to the body of evidence that suggests that although NHL is appearing more often in the post-HAART era, HAART can still positively affect outcome.
Overall, non-Hodgkin lymphoma diagnoses have risen sharply in the post-HAART era. Almost 16% of all AIDS-defining illnesses seen in the EuroSIDA cohort in 1998 were NHL, and last year, when the Chelsea & Westminster’s Kobler Centre reviewed the cause of death of the last 100 patients to die of AIDS-related illnesses, 13 died of NHL compared with three in the pre-HAART era. Additionally, it has been found that in comparison with the general population the risk for non-Hodgkin lymphoma is 100 to 400 times higher in people with HIV.
Investigators in Germany analysed 203 HIV-infected patients diagnosed with non-Hodgkin lymphoma between January 1990 and December 2001, looking at their use of and response to HAART which they defined as either an increase of more than 100 CD4 cells/mm3 or at least one viral load measurement below 500 copies/mL, or both.
Between 1997 and 2001, 71% received HAART during the first two years of their NHL diagnosis, and 78% received chemotherapy, usually CHOP. Those receiving chemotherapy and HAART were significantly more likely to achieve complete remission (71% vs. 48%; p = 0.006). This compares with an overall complete remission rate of 57%, which is similar to rates seen in other cohorts (43-67%). Although it could be argued that those who achieved complete remission were more likely to be well enough to tolerate HAART, the investigators also found that response to HAART was an independent predictor for prolonged survival even adjusting for complete remission (Relative Hazard 0.32; p = 0.0008).
Although the average time of survival from diagnosis to death was only 9 months in the total cohort, 83% of those who achieved both a complete remission and responded to HAART were still alive after 39 months.
The authors found that the traditional factors previously associated with doing poorly with NHL are changing in the HAART era, and that whilst a prior AIDS diagnosis and extranodal involvement (spread of cancer outside of the lymph nodes) were still associated with poor outcome, “response to chemotherapy and response to HAART were independently associated with improved survival.”
Further information on this website
Hoffmann C et al. Response to highly active antiretroviral therapy strongly predicts outcome in patients with AIDS-related lymphoma. AIDS; 17(10):1521-1529, 2003.