GASTROINTESTINAL LYMPHOMAS IN PATIENTS WITH AIDS

Non-Hodgkin-lymphoma (NHL) - most frequently high grade B-cell lymphom a - occurs in 5-10% of individuals with HIV-infection. The gastrointes tinal tract (GIT) is the most frequent extranodal site of the disease. The optimal therapy for HIV-related lymphoma remains a matter of cont roversy. In a retrospective analysis we found gastrointestinal lymphom a in ten of 306 HIV-infected patients (3,3%) with a median CD4-count o f 92/mu l at time of diagnosis. Median survival for the chemotherapy t reatment group was 15 months. The high incidence of gastrointestinal N HL prompted us to commence a prospective survey on diagnostic procedur es, therapy and outcome of patients with HIV-infection and gastrointes tinal symptoms. 93 of 341 HIV-infected patients with gastrointestinal symp toms were examined by endoscopy. In selected patients we used in addition endoscopic ultrasound (EUS) for visualization and staging bef ore and after chemotherapy. NHL of the GIT was detected in seven of 93 endoscopically examined patients (7,5%). All patients were treated wi th CHOP initially. Mean survival time was ten months, mean CD4-count a t diagnosis 193/mu l (range 0-417). Our results indicate that the diag nosis of gastrointestinal lymphoma should be considered in any HIV-inf ected patient presenting with unexplained gastrointestinal symptoms. I n this group of patients NHL was detected in 7,5% of cases. The use of EUS improves the staging procedure before therapy. Treatment with CHO P resulted in relatively high remission rates and was associated with a low rate of treatment-induced myelosuppression.