MALIGNANT GASTROINTESTINAL LYMPHOMAS IN PATIENTS WITH AIDS

HIV-associated malignant lymphomas are a common complication in late H IV infection, and there is a high percentage of gastrointestinal tract involvement. Non-Hodgkin's lymphoma was found in 108 of 2,750 HIV-pos itive patients (3.9%) in our institution, whereas gastrointestinal man ifestation was diagnosed in 48 of 108 patients (44.4%). 44 of these ca ses were found during endoscopy of the upper and low er gastrointestin al tract (or by laparotomy or laparoscopy in 4 cases). Endoscoyy is a reliable procedure for the diagnosis of lymphoma. Unusual manifestatio ns such as oral, esophageal or perianal lesions and multifocal disease were common findings, Life-threatening complications such as gastroin testinal bleeding, perforation, and obstruction occurred in 37.5%. Hig h-grade B-cell lymphomas were found in all cases including mainly lymp hoblastic, immunoblastic. centroblastic and Burkitt subtypes. 52% of t he patients had disseminated lymphoma with Ann Arbor stage III or IV. Standard chemotherapy with cyclophosphamide, adriamycin, vincristine a nd prednisone was started in 25 patients and resulted in a mean surviv al time of 4.8 months. The prognosis of AIDS patients presenting with malignant gastrointestinal lymphoma depends mainly on the presence or absence of previous AIDS-defining diseases, not CD4 cells, lymphoma-as sociated gastrointestinal complications or the histopathologic lymphom a type at the time of diagnosis.