The Changing Landscape of Lymphoma Associated with HIV Infection
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LYMPHOMAS (MR SMITH, SECTION EDITOR)
The Changing Landscape of Lymphoma Associated with HIV Infection Kai Hübel 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Cancer remains a major cause of morbidity and mortality in HIV-infected individuals, with aggressive nonHodgkin’s lymphoma as the most frequent one. However, the introduction of modern antiretroviral therapy (ART) drastically improved treatment options and prognosis in HIV-associated lymphomas. This review summarized the current treatment landscape and future challenges in HIV-positive patients with non-Hodgkin’s and Hodgkin’s lymphoma. Recent Findings Selecting the appropriate therapy for the individual patient, diffuse-large B cell lymphoma, Burkitt’s lymphoma, and Hodgkin’s disease may be curable diseases. In contrast, the prognosis of plasmablastic lymphoma and primary effusion lymphoma remain poor. New treatment approaches, as targeted therapies or CAR T cell therapy, may broaden the therapeutic armamentarium. Summary The continuous application of ART is mandatory for successful treatment. The choice of lymphoma therapy may follow the recommendations for HIV-negative patients, but prospective trials in HIV-lymphoma are needed. Keywords HIV lymphoma . Pathogenesis . Treatment . Risk factors . Antiretroviral therapy
Introduction At the beginning of the 1980s, morbidity and mortality of the acquired immune deficiency syndrome (AIDS) were mainly associated with opportunistic infections such as Pneumocystis jirovecii (formerly known as P. carinii) or infections with cytomegalovirus (CMV). However, it was quickly learned that patients infected with the human immunodeficiency virus (HIV) also have a high risk of developing several forms of cancer. These malignancies may arise when the CD4 T cell count is low and the immune system is compromised. Virally induced neoplasia such as Kaposi’s sarcoma, cervical cancer, and aggressive non-Hodgkin’s lymphoma (NHL) have been defined as AIDS-related cancers. Nowadays, this definition is somewhat anecdotal. With the introduction of combination antiretroviral therapy (cART) in 1996, not only the risk of opportunistic infections declined but also the risk of
developing cancer. Furthermore, the availability of cART broadens the spectrum of therapeutic options for the treating oncologist. Nevertheless, cancer remains a major cause of mortality in HIV-infected individuals, with HIV-associated NHL as the most frequent one [1]. Being infected with HIV is associated with an increased risk for the development of lymphoid malignancies as compared with the general population. The most frequent subtypes of HIV-associated NHL are the diffuse large B cell lymphoma (DLBCL) and the Burkitt’s lymphoma (BL) [2]. The classical Hodgkin’s lymphoma (HL) is one of the most common non-AIDS defining malignancies, with a 5to 20-fold higher risk compared with HIV-negative individuals [3]. There is no doubt that understanding of the underlying mechanisms of HIV-associated lymphoma development a
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