Incidence and management of AIDS-related lymphoma

Over time, the spectrum of the acquired immune deficiency syndrome (AIDS) e pidemic has changed, especially with the advent of highly active antiretrov iral therapy (HAART), The goal of this article is to delineate changes occu rring in the incidence and management of lymphoma over the course of the AI DS epidemic. Lymphoma usually occurs rather late in the course of human imm unodeficiency virus (HIV) infection and is the cause of death in up to 20% of HIV-infected individuals, It is seen in all population groups at risk fo r HN and is more common in men than in women, It is usually diagnosed in pa tients with markedly decreased CD4 cell counts, consistent with prolonged p eriods of HIV infection and subsequent immunosuppression, Recent data from several large series have demonstrated a substantial decline in the median CD4 cell count among patients with newly diagnosed AIDS-related lymphoma de spite the recent widespread use of HAART. While still somewhat controversia l, use of HAART has generally not produced a significant decline in the inc idence of AIDS-related lymphoma. Patients treated with low-dose vs standard -dose chemotherapy for AIDS-related lymphoma have achieved similar response and survival rates, although standard-dose therapy is associated with grea ter toxicity. Adapting therapy to prognostic factors has not produced a sig nificant improvement in survival. Use of antiretroviral therapy along with chemotherapy appears safe, and may be associated with longer survival, An i nfusional regimen called EPOCH (etoposide, prednisone, vincristine [Oncovin ], cyclophosphamide, doxorubicin HCl) shows promise in the future managemen t of AIDS-related lymphoma, No regimen is currently considered the standard of therapy for patients with relapsed AIDS-related lymphoma, and survival is short in this setting.