Short communication: spectrum of non-Hodgkin lymphoma in an urban Ryan White-funded clinic in the established antiretroviral era.

[primary effusion lymphoma]

People living with HIV /AIDS (PLWHA ) are at a higher risk of developing non-Hodgkin lymphoma (NHL ). The influence of combined antiretrovirals (cART ) on the presentation , treatment , and outcomes of HIV-associated NHL (HIV-NHL ) warrants further investigation . We performed a retrospective analysis of PLWHA diagnosed with NHL who received care at the Infectious Diseases Ponce de Leon Center in Atlanta , Georgia , from January 1 , 2004 to December 31 , 2010 . Thirty -five patients with HIV-NHL were identified . Among these patients , 7 had Burkitt lymphoma (BL ), 20 had diffuse large B cell lymphoma (DLBCL ), 7 had plasmablastic lymphoma (PL ), and 1 had primary effusion lymphoma (PEL ). The majority of patients (82 .9 %) presented with advanced disease , and 63 % were not on ART at diagnosis . Despite having good performance status at presentation , the majority of patients presented with high International Prognostic Index (IPI ) scores . There were differences between the histologic subtypes of NHL in regard to treatment , complications , and outcomes . The median CD 4 lymphocyte count at diagnosis was 110 cells /mm (3 ) for patients with DLBCL [interquartile range (IQR ): 66 , 203 ], 165 cells /mm (3 ) for Burkitt lymphoma (IQR : 36 , 199 ), and 98 cells /mm (3 ) for plasmablastic lymphoma (IQR : 34 , 214 ). Overall , patients completed 67 % of planned chemotherapy cycles . Common causes for chemotherapy termination were persistent myelosuppression (18 .2 %), social factors (22 .7 %), and disease progression (36 .4 %). Social factors included lack of transportation , substance abuse , unstable housing , and poor adherence . Two -year overall survival was 40 % for all HIV-NHL . Half of the patients with DLBCL (n =10 ), 42 % of patients with PL (n =3 ), and only 14 .3 % of patients with BL (n =1 ) were alive at 2 years . Among the overall survivors at 2 years , 85 .7 % had CD 4 >200 cells /mm (3 ) and 78 .6 % had undetectable HIV viral loads (VL ) at that time .