Adult Burkitt's lymphoma in patients with and without human immunodeficiency virus infection in Kenya

Prior to the acquired immunodeficiency syndrome (AIDS) epidemic, one or two cases of adult Burkitt's lymphoma (BL) were seen annually at the Kenyatta National Hospital, the national referral medical center in Nairobi, Kenya, To investigate the influence of human immunodeficiency virus (HIV) infectio n in adult BL in Kenya, we conducted a national prevalence survey of all pa tients 16 years of age and older with BL, A systematic review of medical re cords of all patients diagnosed with BL between 1992 and 1996 was performed . The diagnosis of BL was based and confirmed on review of pathological mat erial from time of original diagnosis. HIV serology was confirmed by enzyme -linked immunosorbent assay (ELISA), Twenty-nine adult patients with BL wer e identified during the 5-year study period. Of these patients, 17 (59%) we re males, 12 (41%) were females, and the median age was 26 years, Nineteen patients (66%) with BL were HIV-seropositive. The proportion of men was sim ilar in HIV-seropositive and -seronegative patients (58% vs 60%), HIV-serop ositive BL patients were significantly older than seronegatives (median 35 vs 19.5 years, p < 0.001), HIV seropositive patients uniformly presented wi th constitutional or B symptoms and advanced BL accompanied by diffuse lymp h node involvement, whereas the clinical presentation of HIV-seronegative p atients during this time period was reminiscent of the "typical" endemic pa ttern of disease with complete sparing of peripheral lymph nodes. The overa ll survival of HIV-seropositive cases was significantly worse than that of the HIV-seronegative cases; median survival in the HIV-seropositive patient s was 15 weeks. There is an approximate 3-fold increase in the incidence of adult BL during the time period of this study, which is attributable to th e AIDS epidemic. In this setting, patients often present with disseminated disease, diffuse peripheral lymphadenopathy and fever, the latter two of wh ich heretofore have been commonly associated with non-lymphoproliferative d isorders such as Mycobacterium tuberculosis and sexually transmitted diseas es in Kenya, These observations warrant inclusion of AIDS-related BL in the differential diagnosis of the adult patient with unexplained fever and lym phadenopathy in Kenya, The corollary is that HIV infection is virtually exc luded in an adult patient without peripheral lymphadenopathy and biopsy-pro ven BL, (C) 2001 Wiley-Liss, Inc.