Important note: Information in this article was accurate in September 2000. The state of the art may have changed since the publication date.
Although highly active antiretroviral therapy (HAART) has greatly reduced the appearance of many AIDS-related complications, it does not appear to have reduced levels of an AIDS-related cancer called NHL ( non-Hodgkin's lymphoma). A recently published British study involving 8,000 people looked for changes in NHL before and after HAART became available. The researchers found little change when they looked at the symptoms associated with NHL or survival after a diagnosis of this cancer. Nor did they find that lymphoma rates were on the increase. They did, however, reach some interesting conclusions about NHL in the age of HAART which we report below.
Researchers reviewed data on 7,840 subjects (8% female, 92% male) collected between 1986 to October 1999. They also divided their subjects into the following two groups:
Researchers found that 150 subjects developed NHL that had spread to several parts of the body. Between 5 to 19 PHAs each year developed NHL. Importantly, researchers did not find any significant increase in NHL over the course of their study.
In the time before HAART, for 1% of PHAs, NHL was their first AIDS-related illness. Since HAART became available, this figure has increased to almost 6%. The doctors note that this increase occurred because PHAs aren't developing the usual AIDS-related illnesses such as PCP, CMV or MAC.
According to their analysis, the researchers found that PHAs who were 37 years or older were three times more likely to develop NHL than those PHAs 25 years or younger. This difference was statistically significant. The following features did not affect the risk for developing NHL:
As with other AIDS-related illnesses, the lower the CD4+ count, the greater the risk of developing NHL. The researchers found two important benchmarks associated with the risk of developing NHL. The first was a CD4+ cell count of 350. Subjects with fewer than 350 CD4+ cells were 14 times more likely to develop NHL than those whose counts remained above 350 cells.
The second benchmark was a CD4+ count of 114 cells. Subjects whose CD4+ counts fell below this level were twice as likely to develop NHL compared to subjects whose counts remained above 114 cells.
Researchers found that those subjects who used HAART were significantly less likely to develop NHL than those subjects who used nukes alone.
The following proportion of each group survived for two years after their diagnosis and treatment of NHL:
This difference between the two groups was not statistically significant.
1. Matthews GV, Bower M, Mandalia S, et al. Changes in acquired immunodeficiency syndrome-related lymphoma since the introduction of highly active antiretroviral therapy. Blood 2000 Oct 15;96(8):2730-4.
2. Mocroft A, Katlama C, Johnson AM, et al. AIDS across Europe, 1994-1998: the EuroSIDA study. Lancet 2000 Jul 22;356(9226):291-6.
3. Powles T, Matthews G and Bower M. AIDS related systemic non-Hodgkin's lymphoma. Sexually Transmitted Infections 2000;76:335-341.
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