AIDS-related lymphoma

AIDS-related lymphoma refers to a group of cancers that affect the lymphatic system in individuals with Acquired Immunodeficiency Syndrome (AIDS), a condition caused by the Human Immunodeficiency Virus (HIV). These lymphomas are a significant cause of morbidity and mortality in HIV-infected individuals, despite the advent of antiretroviral therapy (ART) which has improved the overall prognosis for those living with HIV.

Etiology and Pathogenesis

AIDS-related lymphomas are primarily classified into non-Hodgkin lymphoma (NHL) and, less commonly, Hodgkin lymphoma (HL). The pathogenesis of these lymphomas in HIV-infected individuals is complex, involving immunosuppression, chronic antigenic stimulation, and coinfection with oncogenic viruses such as Epstein-Barr Virus (EBV) and Human Herpesvirus 8 (HHV-8), also known as Kaposi sarcoma-associated herpesvirus (KSHV).

Clinical Presentation

Patients with AIDS-related lymphoma may present with B symptoms (fever, weight loss, and night sweats), lymphadenopathy, hepatosplenomegaly, and various extranodal manifestations depending on the specific type of lymphoma. Central nervous system involvement is more common in AIDS-related lymphomas than in lymphomas in the general population.

Diagnosis

The diagnosis of AIDS-related lymphoma involves a combination of clinical evaluation, imaging studies, laboratory tests including HIV and CD4 count, and histopathological examination of lymph node or extranodal tissue biopsies. Immunophenotyping and molecular studies are essential for subclassification and prognostication.

Treatment

The treatment of AIDS-related lymphoma has evolved significantly with the introduction of ART. The management strategy includes antiretroviral therapy, chemotherapy, and, in selected cases, radiation therapy. The choice of chemotherapy regimen depends on the type and stage of lymphoma, but it often involves combinations that include rituximab, a monoclonal antibody against the CD20 antigen on B cells. The integration of ART with chemotherapy has improved outcomes, but treatment must be carefully managed to avoid interactions and enhance tolerability.

Prognosis

The prognosis of AIDS-related lymphoma has improved with the use of ART and modern chemotherapy regimens. However, outcomes vary depending on a range of factors including the type of lymphoma, stage at diagnosis, response to ART, and the patient's immune status.

Prevention and Screening

Preventive measures for AIDS-related lymphoma primarily involve the effective management of HIV infection with ART to maintain a high CD4 count and minimize immunosuppression. Regular monitoring of HIV-infected individuals for early signs of lymphoma is also crucial for early detection and treatment.