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24 - HIV-related lymphomas

Published online by Cambridge University Press:  10 January 2011

By
Caroline M. Behler  and
Lawrence D. Kaplan
Edited by
Susan O'Brien ,
Julie M. Vose  and
Hagop M. Kantarjian
Caroline M. Behler
Affiliation:
San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 111H1, San Francisco, CA, USA
Lawrence D. Kaplan
Affiliation:
Division of Hematology/Oncology, University of California San Francisco, CA, USA
Susan O'Brien
Affiliation:
University of Texas/MD Anderson Cancer Center, Houston
Julie M. Vose
Affiliation:
University of Nebraska Medical Center, Omaha
Hagop M. Kantarjian
Affiliation:
University of Texas/MD Anderson Cancer Center, Houston
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Summary

Epidemiology/etiology

Ever since the beginning of the HIV/AIDS pandemic, it has been recognized that in addition to the increased risk of opportunistic and other infections, the incidence of malignancy is much greater in people with HIV/AIDS (PWHA) than that of the general population. This risk is likely a direct result of the immune dysfunction from chronic HIV infection, though concomitant viral infections including Epstein–Barr virus (EBV), human herpesvirus 8 (HHV-8), and human papilloma virus (HPV) also play a role. While the incidence of cancers is increased both for PWHA and immunosuppressed organ transplant patients, the risk of non-Hodgkin (NHL) and Hodgkin (HL) lymphomas appears to be significantly greater in the setting of HIV/AIDS compared to the transplant population.

This risk of NHL is 25- to 200-fold increased in PWHA compared to those without HIV, and risk appears to increase with duration of HIV infection as well as with lower CD4 counts. The risk of HL, while not considered an AIDS-defining illness (ADI) by the Centers for Disease Control, is increased by about 5- to 15-fold in PWHA; however, its incidence is decreased with lower CD4 counts. Since the widespread introduction of highly active antiretroviral therapy (HAART) in the mid-1990s, the incidence of ADIs and mortality among PWHA has decreased dramatically and many studies have reported an increase in the proportion of ADIs attributable to HIV-related lymphomas (HRL).

Type
Chapter
Information
Management of Hematologic Malignancies , pp. 462 - 486
Publisher: Cambridge University Press
Print publication year: 2010

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