Division of Infectious Diseases, The Ruth M, Rothstein CORE Center, 2020 W, Harrison St,, Chicago, Illinois, 60612, USA.
AIDS Res Ther. 2010 Dec 14;7:44. doi: 10.1186/1742-6405-7-44.
In the HAART era, the incidence of HIV-associated non-Hodgkin lymphoma (NHL) is decreasing. We describe cases of NHL among patients with multi-class antiretroviral resistance diagnosed rapidly after initiating newer-class antiretrovirals, and examine the immunologic and virologic factors associated with potential IRIS-mediated NHL.
During December 2006 to January 2008, eligible HIV-infected patients from two affiliated clinics accessed Expanded Access Program antiretrovirals of raltegravir, etravirine, and/or maraviroc with optimized background. A NHL case was defined as a pathologically-confirmed tissue diagnosis in a patient without prior NHL developing symptoms after starting newer-class antiretrovirals. Mean change in CD4 and log10 VL in NHL cases compared to controls was analyzed at week 12, a time point at which values were collected among all cases.
Five cases occurred among 78 patients (mean incidence = 64.1/1000 patient-years). All cases received raltegravir and one received etravirine. Median symptom onset from newer-class antiretroviral initiation was 5 weeks. At baseline, the median CD4 and VL for NHL cases (n = 5) versus controls (n = 73) were 44 vs.117 cells/mm3 (p = 0.09) and 5.2 vs. 4.2 log10 (p = 0.06), respectively. The mean increase in CD4 at week 12 in NHL cases compared to controls was 13 (n = 5) vs. 74 (n = 50)(p = 0.284). Mean VL log10 reduction in NHL cases versus controls at week 12 was 2.79 (n = 5) vs. 1.94 (n = 50)(p = 0.045).
An unexpectedly high rate of NHL was detected among treatment-experienced patients achieving a high level of virologic response with newer-class antiretrovirals. We observed trends toward lower baseline CD4 and higher baseline VL in NHL cases, with a significantly greater decline in VL among cases by 12 weeks. HIV-related NHL can occur in the setting of immune reconstitution. Potential immunologic, virologic, and newer-class antiretroviral-specific factors associated with rapid development of NHL warrants further investigation.
在高效抗逆转录病毒治疗（HAART）时代，HIV 相关非霍奇金淋巴瘤（NHL）的发病率正在下降。我们描述了在开始使用新型抗逆转录病毒药物后迅速诊断出具有多种抗逆转录病毒耐药性的患者中 NHL 的病例，并研究了与潜在免疫重建炎症综合征（IRIS）介导的 NHL 相关的免疫和病毒学因素。
在 2006 年 12 月至 2008 年 1 月期间，来自两个附属诊所的符合条件的 HIV 感染患者接受了优化背景下的拉替拉韦、依曲韦林和/或马拉维若治疗的扩大获得性方案抗逆转录病毒药物。NHL 病例被定义为在开始使用新型抗逆转录病毒药物后没有先前 NHL 症状的患者中经组织病理学证实的组织诊断。在所有病例中均在第 12 周收集了 NHL 病例与对照组之间的 CD4 和 log10 VL 的平均变化。
在 78 名患者中有 5 例（发生率平均为 64.1/1000 患者年）。所有病例均接受了拉替拉韦治疗，1 例接受了依曲韦林治疗。从开始新型抗逆转录病毒治疗到症状出现的中位时间为 5 周。在基线时，与对照组（n=73）相比，NHL 病例（n=5）的 CD4 和 VL 中位数分别为 44 与 117 个细胞/mm3（p=0.09）和 5.2 与 4.2 log10（p=0.06）。与对照组相比，NHL 病例在第 12 周时的 CD4 平均增加量为 13（n=5）与 74（n=50）（p=0.284）。与对照组相比，NHL 病例在第 12 周时的 VL log10 降低量为 2.79（n=5）与 1.94（n=50）（p=0.045）。
在接受新型抗逆转录病毒药物治疗并实现高病毒学反应的治疗经验丰富的患者中，检测到 NHL 的发生率出乎意料地高。我们观察到 NHL 病例的基线 CD4 较低和基线 VL 较高的趋势，并且在 12 周时病例的 VL 下降幅度明显更大。HIV 相关 NHL 可在免疫重建的情况下发生。与 NHL 快速发展相关的潜在免疫、病毒学和新型抗逆转录病毒特异性因素需要进一步研究。
