The influence of HAART on HIV-associated primary cerebral lymphoma: Declining incidence and improving survival

Abstract

17512 Background: The risk of primary central nervous system lymphoma (PCL) is increased in individuals infected with the human immunodeficiency virus type-1 (HIV-1). As highly active anti-retroviral therapy (HAART) has reduced morbidity and mortality secondary to HIV, we investigated the effect of HAART on the presentation and outcome of HIV infected individuals with PCL. Methods: From a single centre cohort of 9,621 HIV infected individuals, patients with PCL were identified. We compared pre-HAART and HAART era clinico-pathologic variables and investigated whether exposure to anti-retrovirals with differing CNS penetrations, protected from the development of this AIDS-defining illness. Results: In 61 patients diagnosed with PCL and a median survival of 1.3 months, we observed a decreased incidence of PCL in the HAART era compared to the pre HAART era (χ2 p = 0.0001), and a significantly improved overall survival (Log rank p = 0.032). In the HAART era there were fewer patients with prior AIDS defining illnesses (χ2 p = 0.015) and patients were significantly more likely to have the diagnosis confirmed histologically or by CSF PCR examination (χ2 p < 0.0001). Exposure to specific anti-retrovirals did not protect from the development of PCL, regardless of cerebro-spinal fluid (CSF) penetration. Conclusions: Although the prognosis remains dismal, the HAART era has decreased the incidence and prolonged the survival of individuals with HIV-1 associated PCL. No significant financial relationships to disclose.