Better response to chemotherapy and prolonged survival in AIDS-related lymphomas responding to highly active antiretroviral therapy

Objectives: To evaluate the impact of response to highly active antiretrovi ral therapy (HAART) on the natural history of AIDS non-Hodgkin's lymphoma ( NHL) and to analyse the feasibility, efficacy and toxicity of HAART in comb ination with chemotherapy. Design: Prospective observational study in two AIDS clinical centres in Ita ly. Methods: All consecutive HIV-infected patients with NHL were included (n = 44; 48% high-risk group) and prospectively followed for 27 months. HAART wa s administered concomitantly with chemotherapy. The association between res ponse to HAART and clinical presentation, response to chemotherapy and toxi city was analysed by univariate and multivariate models. Survival analysis was performed by Kaplan-Meier estimates and the Cox proportional hazards re gression model. Results: A complete response (CR) to chemotherapy was achieved in 71% of HA ART responders and 30% of non-responders. Virological response to HAART was the only variable associated with tumour response on multivariate analysis . A higher relative dose intensity (RDI) of chemotherapy was administered i n patients with virological response compared with those without. The proba bility of 1 year survival was higher in patients with virological or immuno logical response. At Cox regression analysis, immunological response, a hig her RDI and a CIR to chemotherapy were all associated with a reduced risk o f death. Conclusion: In HIV-infected patients with NHL, response to HAART was strong ly associated with a better response to chemotherapy and prolonged survival . Concurrent treatments were well tolerated, and HAART-responder patients c ould receive a higher RDI of chemotherapy. In patients with AIDS lymphomas, combining HAART with chemotherapy could be a feasible and effective approa ch. (C) 2001 Lippincott Williams & Wilkins.