HIV-Related Lymphoproliferative Diseases in the Era of Combination Antiretroviral Therapy

• Published in: Cardiovascular & hematological disorders drug targets Vol. 20; no. 3; p. 175
• Main Authors: Castelli, Roberto, Schiavon, Riccardo, Preti, Carlo, Ferraris, Laurenzia
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 2020
• Subjects: Animals; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active; HIV - drug effects; HIV - immunology; HIV - physiology; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; Humans; Lymphoma, AIDS-Related - drug therapy; Lymphoma, AIDS-Related - etiology; Lymphoma, AIDS-Related - immunology; Lymphoma, AIDS-Related - virology; Lymphoproliferative Disorders - drug therapy; Lymphoproliferative Disorders - etiology; Lymphoproliferative Disorders - immunology; Lymphoproliferative Disorders - virology; Virus Replication - drug effects; central nervous system lymphomas (PCNSL); diffuse large B-cell lymphoma (DLBCL); burkitt lymphoma (BL); plasmablastic lymphoma (PL); Human immunodeficiency virus (HIV) lymphomas; combination antiretroviral therapy (CART); hodgkin lymphoma (HL); primary effusion lymphoma (PEL)
• ISSN: 2212-4063
• DOI: 10.2174/1871529X20666200415121009

HIV-positive patients have a 60- to 200-fold increased incidence of Non-Hodgkin Lymphomas (NHL) because of their impaired cellular immunity. Some NHL are considered Acquired Immunodeficiency Syndrome (AIDS) defining conditions. Diffuse large B-cell Lymphoma (DLBC) and Burkitt Lymphoma (BL) are the most commonly observed, whereas Primary Effusion Lymphoma (PEL), Central Nervous System Lymphomas (PCNSL), Plasmablastic Lymphoma (PBL) and classic Hodgkin Lymphoma (HL) are far less frequent. Multicentric Castleman disease (MCD) is an aggressive lymphoproliferative disorder highly prevalent in HIV-positive patients and strongly associated with HHV-8 virus infection. In the pre-Combination Antiretroviral Therapy (CART) era, patients with HIV-associated lymphoma had poor outcomes with median survival of 5 to 6 months. By improving the immunological status, CART extended the therapeutic options for HIV positive patients with lymphomas, allowing them to tolerate standard chemotherapies regimen with similar outcomes to those of the general population. The combination of CART and chemotherapy/ immuno-chemotherapy treatment has resulted in a remarkable prolongation of survival among HIVinfected patients with lymphomas. In this short communication, we briefly review the problems linked with the treatment of lymphoproliferative diseases in HIV patients. Combination Antiretroviral Therapy (CART) not only reduces HIV replication and restores the immunological status improving immune function of the HIV-related lymphomas patients but allows patients to deal with standard doses of chemotherapies. The association of CART and chemotherapy allowed to obtain better results in terms of overall survival and complete responses. In the setting of HIVassociated lymphomas, many issues remain open and their treatment is complicated by the patient's immunocompromised status and the need to treat HIV concurrently.