Evolving characteristics of AIDS-related lymphoma

Over time, the epidemiologic and demographic characteristics of AIDS have c hanged in the United States, while the use of highly active antiretroviral therapy has changed the natural history of the disease. The goal of the stu dy was to ascertain any changes in the epidemiologic, immunologic, patholog ic, or clinical characteristics of AIDS-related lymphoma (ARL) over the cou rse of the AIDS epidemic. Records of 369 patients with ARL diagnosed or tre ated at a single institution from 1982 through 1998 were reviewed. Single i nstitutional data were compared to population-based data from the County of Los Angeles. Significant changes in the demographic profile of patients wi th newly diagnosed ARL have occurred, with the later time intervals associa ted with a higher prevalence in women (P = .25), in Latino/Hispanic individ uals (P < .0001), and in those who acquired human immunodeficiency virus (H IV) heterosexually (P = .01). These changes were similar in both countywide , population-based analyses and in those from the single institution. The m edian CD4(+) lymphocyte count at lymphoma diagnosis has decreased significa ntly over the years, from 177/dL in the earliest time period (1982-1986), t o 53/dL in the last time period from 1995 to 1998 (P = .0006). The patholog ic spectrum of disease has also changed, with a decrease in the prevalence of small noncleaved lymphoma (P = .0005) and an increase in diffuse large c ell lymphoma (P < .0001). Despite changes in the use of antiretroviral or c hemotherapy regimens, the median survival has not significantly changed. (C ) 2000 by The American Society of Hematology.