Management of AIDS-related lymphoma

With the advent of highly active antiretroviral therapy, the epidemiology of AIDS-lymphoma has changed, and prognosis has improved. Paradigms of therapy have changed. Although the incidence of AIDS-lymphoma has decreased, the incidence of HIV-associated Hodgkin's lymphoma has increased; mechanisms for these changes in epidemiology will be discussed.

Use of highly active antiretroviral therapy, either concomitantly or immediately after completion of chemotherapy, has resulted in rates of complete remission and survival that are similar to those in HIV-negative patients. The use of rituximab, while initially controversial because of reports of increased risk of infectious death, is associated with improved outcome; the increased risk of infectious death has not been confirmed. The infusional etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin regimen is associated with excellent results. High-dose chemotherapy with autologous stem cell transplant is associated with long-term, disease-free survival in approximately 50-80% of patients with relapsed/refractory AIDS-lymphoma.

Highly active antiretroviral therapy should be used with chemotherapy. Addition of rituximab is associated with improved response rates, without an increase in infections. Infusional etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin is associated with excellent results among patients with either diffuse large B cell lymphoma or Burkitt's lymphoma. Optimal therapy for patients with HIV-Hodgkin's lymphoma has not yet been defined.