AIDS-related lymphoma (ARL): Efficacy of highly active anti retroviral therapy (HAART) on survival and prognostic factors in a general hospital in Peru

Abstract

e19545 Background: Since the introduction of HAART in 1996, the profile of ARL has shifted considerably. The impact of HAART on the survival of ARL in developing countries in the post-HAART era has not been clearly defined. The aims of this study were to evaluate efficacy of HAART on survival and prognostic factors in our population. Methods: The clinical records of 2,502 HIV-infected patients seen in our institution from March 1997 to March 2008 were reviewed. The survival was calculated using the Kaplan-Meier method and the prognostic factors were evaluated by chi square. Results: Forty-eight patients with HIV-associated lymphoma were identified. From the 48 ARL identified 44 were non Hodgkin lymphoma (NHL) and 4 were Hodgkin lymphoma. Two patients with CNS primary were excluded for analysis. From 42 systemic NHL: 38 (90,5%) were of B-cell and 4 (9,5%) were of T-cell. The 5-year overall survival (OS) was 27%. Three groups of patients were included: 13 patients (31%) received HAART previous the diagnosis of ARL, 21 patients (50%) initiated HAART after ARL diagnosis and 8 patients (19%) did not receive HAART. HAART treatment before the diagnosis of NHL increases the survival (54% versus 9,5% versus 25% respectively, p=0.048). Twenty of 42 patients (47,6%) received chemotherapy. This group had a better survival rate than those who did not receive chemotherapy (50% versus 4,5%, p< 0.0001) The overall response to chemotherapy was 80% with CR (n=11, 55%), PR(n=5, 25%) and PD in four (20%). In a multivariate analysis, IPI score > 2, presence of B symptoms and no HAART previous ARL diagnosis were statistically associated to worse survival with p-values of 0.0001, 0.018 and 0.048 respectively. Conclusions: In our study the use of HAART is effective when started before ARL diagnosis. IPI score > 2, B symptoms and no HAART previous the diagnosis were unfavorable prognostic factors. These latest findings are in concordance with prior reports. This is the first Latinamerican report on the impact of HAART on the OS in ARL patients. No significant financial relationships to disclose.