HAART Era Research Articles

Survival comparison between malignant lymphoma HIV+ versus HIV- in the post HAART era: INEN 2005-2011.

e18524 Background: The incidence of non-Hodgkin lymphoma in HIV patients (ARLs) is higher than in general population. In the HAART era AIDS-related lymphoma (ARL) are more frequent in patients with advanced age, delayed diagnosis, non adherent HAART, multiresistant strains of HIV. The aim of this study is to compare the clinical characteristic, prognosis factors and survival of malignant lymphomas HIV( +) vs HIV(-) at the Instituto Nacional de Enfermedades Neoplásicas. Methods: Study retrospective, individually matched, case-controlled study according to HIV serologic status (positive vs negative) for patiens newly diagnosed of non-Hodgkin lymphoma between 2005 and 2011. Results: We included 51 cases HIV (+) and 102 controls HIV (-) (Table). On diagnosis, anemia (Hemoglobin < 110 g/L) and opportunistic infections (OI) were statiscal more frequent (p<0.05) in ARL. The overall response to chemotherapy (ORC) was 76.4% (cases) and 89.2% (controls) (p<0.05). In multivariate analysis ECOG ≥ 2, OI and no response to chemotherapy increase mortality risk in ARL (p<0.05). ARL had lower 6-year Disease Free Survival (DFS) (16.0 vs 25 months) (p>0.05) and lower 6- year Overall survival (OS) (37.9 vs 49.7 months (controls) (p<0.001) than HIV (-) patients. Conclusions: In multivariate analysis ECOG ≥ 2, OI and no response to chemotherapy were adverse prognostic factors for OS in ARL. ORC is lower in ARL, though similar DFS of patients with malignant lymphoma HIV(+) vs HIV(-). [Table: see text]

Oral lesions among HIV seropositive individuals in an era of generic HAART: markers of HAART efficacy?

Results In the study population, 92.3% of individuals had acquired the infection through heterosexual contact. The mean age of infected males and females was 35±8 and 30±8 years respectively and the mean CD4 count in males and females was 385.53±226.76 and 284.36 ±278.28 cells/μL respectively (p 200 (p<0.01). Patients on HAART (n=1042) had a lesser number of lesion than patients not on HAART (p<0.01). Of the lesions, candidiasis was predominantly seen in the nonHAART group (19.7%) as compared to the HAART group (11.7%). Patients who were not on HAART showed a higher prevalence of pseudomembranous candidiasis (12.8% vs.7.9%, p<0.01) and angular cheilitis (6.0% vs.3.7%, p<0.01).

Liver Toxicity of Antiretroviral Drugs

Drug-induced liver injury (DILI) associated with antiretroviral treatment has represented an important side effect since the beginning of the HAART era. The lack of standard definition and specific markers makes assessment of DILI very challenging. Several clinical syndromes of DILI have been described over the years; the pathogenic mechanisms are not fully understood. Better knowledge of DILI, identification of high-risk patients using pharmacogenetics, and the availability of antiretroviral agents with improved safety profile have all contributed to decrease the incidence of DILI and to ameliorate its effects. Nevertheless, with an aging human immunodeficiency virus- (HIV-) infected population and increased survival, DILI will probably continue to represent a relevant entity in e HIV therapeutic management.

Evaluation of the AIDS clinical trials group staging criteria for Kaposi Sarcoma in a resource limited setting

Background Kaposi sarcoma (KS) is commonly staged using by the AIDS Clinical Trials Group (ACTG) criteria. The three variables of the ACTG are dichotomized as good risk (0) and poor risk (1). Good risk immune status (I0) is defined as CD4 T-cell count ≥200cells/µl, and poor risk (I1) as CD4 < 200cells/µl. Although validated in the US and Europe, no evaluation has been done in resourcelimited settings during the HAART era. We sought to determine whether the ACTG staging criteria is predictive of overall survival among Ugandan patients with HIV-associated KS. Methods Data were abstracted from medical records of adult patients with HIV-associated KS seen at the Uganda Cancer Institute (UCI) from 2000-2006. The primary outcome was 2-year overall survival. Vital status at 2 years was determined from the medical chart, or by contacting the patient or next of kin using the phone contact provided in the chart or ART clinic. Survival was modeled using Kaplan-Meier methods. Factors associated with survival were evaluated using Cox proportional hazards.

Demographics and survival of AIDS cases with cancer, Washington, DC, 1996-2006

Background Washington, DC (DC) has one of the highest HIV/AIDS rates in the U.S and cancer is the second leading cause of death among DC residents. This study sought to examine the demographic characteristics and survival of persons with AIDS defining cancers (ADCs) compared to those with non-AIDS defining cancers (NADCs) between the early HAART era (1996-2001) and the late HAART era (2002-2006) in DC.

Errata

IN THE ARTICLE entitled 'HIV-positive patients treated for multidrug-resistant tuberculosis: clinical outcomes in the HAART era' by E. Palacios, M. Franke, M. Muñoz, et al. (Int J Tuberc Lung Dis 2012; 16(3): 348-354; http://dx.doi.org/10.5588/ijtld.11.0473), the name of author M. Lyzigos was spelt incorrectly. It should read: M. Lygizos.

HIV-positive patients treated for multidrug-resistant tuberculosis: clinical outcomes in the HAART era

Multidrug-resistant tuberculosis (MDR-TB) and the human immunodeficiency virus (HIV) pose two of the greatest threats to global tuberculosis (TB) control. Given expanding global access to antiretroviral therapy (ART) and second-line TB drugs, more data are needed on experiences treating MDR-TB and HIV co-infection in resource-poor settings. To describe the clinical characteristics, management, outcomes, and factors associated with survival among HIV-positive individuals receiving treatment for MDR-TB. This was a retrospective case series of 52 HIV-positive individuals receiving treatment for MDR-TB in Lima, Peru. We used Cox proportional hazards regression models to identify risk factors for mortality. A total of 31 (57%) of the cohort died on treatment, with the majority of deaths due to MDR-TB. Low baseline weight predicted a three-fold increased rate of death (aHR 3.1, 95%CI 1.5-6.7), while individuals receiving highly active ART experienced a significantly lower rate of death compared to those who were not (aHR 0.4, 95%CI 0.2-0.9). Early ART is likely a key component of effective MDR-TB management in co-infected individuals.

Causes of death in the HAART era

Compared with vast literature on the clinical, imaging, and in-vivo microbiology aspects of HIV disease, there is less on biopsy pathology and even less on autopsy data. This review focuses on some current clinico-pathological issues, with indications of where there is less certainty than we would like. The most important change in causes of death in HIV disease, since the advent of highly active antiretroviral therapy (HAART), is the reduction of classical AIDS-defining opportunistic diseases, with the compensating increase in background comorbidities related to lifestyle, infections including the hepatitis viruses and HHV8, ageing, drug toxicity and immune reconstitution inflammatory syndrome phenomena. In low-income countries, HIV contributes significantly to maternal mortality. To understand HIV disease better and manage future patients better, we need more tissue clinico-pathological correlation, including quality biopsy and autopsy evaluations.

Clinical Features, Treatment, and Outcome of HIV-Associated Immune Thrombocytopenia in the HAART Era

The characteristics of HIV-associated ITP were documented prior to the HAART era, and the optimal treatment beyond HAART is unknown. We performed a review of patients with HIV-associated ITP and at least one platelet count <20 × 109/L since January 1996. Of 5290 patients in the BC Centre for Excellence in HIV/AIDS database, 31 (0.6%) had an ITP diagnosis and platelet count <20 × 109/L. Initial ITP treatment included IVIG, n = 12; steroids, n = 10; anti-RhD, n = 8; HAART, n = 3. Sixteen patients achieved response and nine patients achieved complete response according to the International Working Group criteria. Median time to response was 14 days. Platelet response was not significantly associated with treatment received, but complete response was lower in patients with a history of injection drug use. Complications of ITP treatment occurred in two patients and there were four unrelated deaths. At a median followup of 48 months, 22 patients (71%) required secondary ITP treatment. This is to our knowledge the largest series of severe HIV-associated ITP reported in the HAART era. Although most patients achieved a safe platelet count with primary ITP treatment, nearly all required retreatment for ITP recurrence. New approaches to the treatment of severe ITP in this population are needed.

Complications of Common Gynecologic Surgeries among HIV-Infected Women in the United States

Objective. To compare frequencies of complications among HIV-infected and-uninfected women undergoing common gynecological surgical procedures in inpatient settings. Methods. We used 1994–2007 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Our analysis included discharge records of women aged ≥15 undergoing hysterectomy, oophorectomy, salpingectomy for ectopic pregnancy, bilateral tubal sterilization, or dilation and curettage. Associations between HIV infection status and surgical complications were evaluated in multivariable logistic regression models, adjusting for key covariates. Results. For each surgery, HIV infection was associated with experiencing ≥1 complication. Adjusted ORs ranged from 2.0 (95% confidence interval (CI): 1.7, 2.2) for hysterectomy with oophorectomy to 3.1 (95% CI: 2.4, 4.0) for bilateral tubal sterilization with no comorbidity present. HIV infection was positively associated with extended length of stay and infectious complications of all of the surgeries examined. For some surgeries, it was positively associated with transfusion and anemia due to acute blood loss. Among HIV-infected women, the odds of infectious and other complications did not decrease between 1994–2000 and 2001–2007. Conclusion. HIV infection was associated with elevated frequencies of complications of gynecologic surgeries in the US, even in the era of HAART.

Echocardiographic findings and their impact on outcomes of critically ill patients with AIDS in the era of HAART.

Objective. To describe the echocardiographic findings in critically ill patients with AIDS and their impact on clinical outcome. Design. A retrospective chart review of consecutive AIDS patients over 18 years of age, who had a trans-thoracic echocardiogram performed during the course of intensive care unit stay over the course of 2 years at a tertiary care hospital. Main outcome measures. The prevalence of echocardiogram abnormalities in this population and its impact on ICU mortality, ICU length of stay, hospital mortality, hospital length of stay and 60 day survival. Results. Among 107 patients who met the inclusion criteria, an admission echocardiogram was performed in 62 (58%). The prevalence of cardiac abnormalities was 60%. The most common admission diagnosis was respiratory failure n = 27 (43%). The most common finding on echocardiogram was left ventricular (LV) dysfunction n = 31 (50%) followed by pulmonary hypertension n = 25 (40%). None of these findings had a significant impact on clinical outcomes. There was trend toward reduced 60 day survival among patients with depressed LV function. Conclusions. Although echocardiogram abnormalities were prevalent among this population none of these findings had a significant impact on ICU mortality or hospital mortality and ICU length of stay or hospital length of stay.

Disclosing HIV to Infected Children in South Africa in the Era of HAART: A Grounded Theory Study on the Process, Reasons and Outcomes of Disclosure

South Africa has seen an increasing population of children and adolescents accessing antiretroviral treatment (ART) in the past seven years. Many of these children are at the age when they should know their HIV diagnosis. We used grounded theory to explore the process, reasons and outcomes of HIV disclosure to children accessing ART from a paediatric HIV clinic in South Africa. Twenty seven caregivers of children aged 6 - 13 years who were receiving ART participated in four focus group interviews. Four main themes, disclosure occurring as a process, asking HIV related questions, the right age to tell, and the child's reaction to the diagnosis emerged. Biological caregivers approached disclosure as a process; they planned and prepared for the disclosure event for a long time. Full disclosure occurred when the caregivers had dealt with their own personal fears over the child's diagnosis, resulting in disclosure being delayed to older age and adolescence. Non-biological caregivers disclosed impulsively to children and employed partial disclosure. Caregivers disclosed because of the child's refusal to continue taking medication or the child repeatedly questioned the reasons for taking medication. Caregivers also disclosed because it was the right time to disclose, and the right time was often when the child reaches adolescence. After learning about their HIV diagnosis children became more adherent to medication, they also ensured that their HIV infected biological caregivers were adherent too. Children kept their diagnosis secret from people outside their immediate families. The increased survival of children on ART in South Africa calls for concerted efforts from researchers and health care providers to develop disclosure guidelines to assist caregivers to disclose to children in a manner that promotes the wellbeing of the child.

Pulmonary Function in HIV-1 Vertically Infected Children

Background: Despite reports of an increasing incidence of asthma in HIV-infected children, exploration of pulmonary function by spirometry has never been reported in this population in the HAART era. Objective: The aim of this study was to determine the prevalence of spirometric abnormalities in HIV-1 infected children. We conducted a cross-sectional study of pulmonary function tests (PFT) in HIV-1 vertically infected children. Methods: Spirometric values were measured in 17 HIV-1 chronically infected children and compared to matched healthy children. In HIV-1 infected children, the correlations between PFT and the determination of the single breath carbon monoxide diffusing capacity of the lung (TL CO ) and immunological and virological values were assessed. Results: Overall, 11 of the 17 PFT were normal. Four showed mild distal obstruction. Two were considered restrictive. When compared with matched healthy children, the only difference was the FEV1/FVC ratio that was significantly lower in the patients’ group (91.9% of predicted value versus 97.1%, p<0.0001). We found a positive correlation between TL CO and the CD4/CD8 T-cell ratio (p=0.012) and viral load (p=0.05). We observed that FEF 25-75 values increased with age and weight in healthy children (p= 0.006 and p=0.007 respectively), but not in infected patients. Conclusions: Our results showed that chronic HIV-1 infection and/or continuous HAART exposure induce a specific response of the pulmonary immune system which may compromise its function with time. If confirmed, it may justify a careful follow-up of pulmonary function in vertically infected children

Morbidity and Mortality Patterns of Hospitalised Adult HIV/AIDS Patients in the Era of Highly Active Antiretroviral Therapy: A 4-year Retrospective Review from Zaria, Northern Nigeria

Background. This study, undertaken in major tertiary hospital in northern Nigeria, examined the morbidity and mortality patterns of hospitalised adult HIV/AIDS patients in the HAART era. Methods. Between January 2006 and December 2009, admission records and causes of deaths of hospitalised medical HIV-infected patients were retrieved and analysed according to antiretroviral (ART) status. Results. Of the 207 HIV/AIDS patients reviewed, majority were newly diagnosed (73.4%), and most were hospitalised and died from various AIDS-defining illnesses, mainly disseminated tuberculosis and sepsis. Immune-inflammatory-reconstitution-syndrome, ART-toxicity and ART-failure, contributed to morbidity and mortality in patients receiving ART. Sixty six (31.9%) patients died, with higher mortality in males and in those with lower CD4-cell count, lower PCV, and shorter hospital stay. However, hospital stay ≤3 days and severe anaemia (PCV < 24%) were independent predictors of mortality. Conclusion. In the current HAART era, late presentation and tuberculosis continue to fuel the HIV/AIDS pandemic in Africa, with emerging challenges due to ART-related complications.

Evolving approaches and resources for clinical practice in the management of HIV infection in the HAART era

Physicians treating HIV infection concentrate not only on the viral management but they also have to take into account the potential age and lifestyle-related conditions likely to influence long-term morbidity, correlated with patients' survival. Hypertension, diabetes, cardiovascular, bone, kidney and liver disease, better than opportunistic infection, depict the changing spectrum of HIV disease in the HAART era. These conditions, the so called non infectious co-morbidities, are age-related diseases affecting the general population. However, their prevalence in HIV-infected individuals is higher, with earlier onset, probably as a result of the complex inter-relationship between HIV infection, co-infection and antiretroviral therapy. Regular screening for non infectious co-morbidities helps identify those asymptomatic HIV-infected individuals who are most at risk of developing comorbidities; this means that appropriate intervention, either by lifestyle changes to reduce modifiable risk factors or by the use of pharmacological management, can be initiated.

High occurrence of HIV-positive siblings due to repeated mother-to-child transmission in Brazil

Pregnancies in women without knowledge of their HIV-positive status increase the risk of mother-to-child transmission, and of disease progression. This study aimed to characterize the frequency of multiple pregnancies and of HIV-positive children in the family, during HAART era. We analyzed data of a national multicenter cohort study among Brazilian children with AIDS diagnosed between 1999 and 2002. In total, 945 children and their 928 mothers were included. Five hundred and ninety (64.6%) women had a history of multiple pregnancies, and 49.5% attended prenatal care (mean: 3.5 consultations; SD 3.6). In 483 child cases, HIV status of the sibling was known; 130 (26.9%) of these were infected with HIV. In 38.5% of cases, the child with AIDS included in the cohort study was the first case in the family. Despite the overall positive results of the Brazilian control policy of HIV/AIDS, our study shows that HIV infection in pregnant women was often undetected and that consequently there was a high frequency of repeated HIV-infected children. There is a need to improve comprehensive prenatal and postnatal care of Brazilian women. HIV-affected families are most vulnerable and should be targeted by specific control programs, preventing additional HIV infections in other children.

How prepared are our future doctors for HIV/AIDS?

Three cohorts (n=391) of final-year medical students in Hong Kong were evaluated on their preparedness to provide HIV care. Through a self-administered questionnaire, half (53%) were assessed to be better prepared and had a lower perceived risk of infection at work, though unwillingness to manage HIV patients was reported in a minority (4.6%). For a majority of medical students (72.8%), a specially-designed clinic attachment offered the only opportunity to come face-to-face with HIV patients for the first time. With continued improvement in treatment effectiveness, HIV/AIDS is evolving to become a new chronic disease in most societies. Curriculum development in HIV medicine remains a challenge in this HAART era.

Central nervous system antiretroviral efficacy in HIV infection: a qualitative and quantitative review and implications for future research

BackgroundThere is conflicting information as to whether antiretroviral drugs with better central nervous system (CNS) penetration (neuroHAART) assist in improving neurocognitive function and suppressing cerebrospinal fluid (CSF) HIV RNA. The current review aims to better synthesise existing literature by using an innovative two-phase review approach (qualitative and quantitative) to overcome methodological differences between studies.MethodsSixteen studies, all observational, were identified using a standard citation search. They fulfilled the following inclusion criteria: conducted in the HAART era; sample size > 10; treatment effect involved more than one antiretroviral and none had a retrospective design. The qualitative phase of review of these studies consisted of (i) a blind assessment rating studies on features such as sample size, statistical methods and definitions of neuroHAART, and (ii) a non-blind assessment of the sensitivity of the neuropsychological methods to HIV-associated neurocognitive disorder (HAND). During quantitative evaluation we assessed the statistical power of studies, which achieved a high rating in the qualitative analysis. The objective of the power analysis was to determine the studies ability to assess their proposed research aims.ResultsAfter studies with at least three limitations were excluded in the qualitative phase, six studies remained. All six found a positive effect of neuroHAART on neurocognitive function or CSF HIV suppression. Of these six studies, only two had statistical power of at least 80%.ConclusionsStudies assessed as using more rigorous methods found that neuroHAART was effective in improving neurocognitive function and decreasing CSF viral load, but only two of those studies were adequately statistically powered. Because all of these studies were observational, they represent a less compelling evidence base than randomised control trials for assessing treatment effect. Therefore, large randomised trials are needed to determine the robustness of any neuroHAART effect. However, such trials must be longitudinal, include the full spectrum of HAND, ideally carefully control for co-morbidities, and be based on optimal neuropsychology methods.

HIV Status Does Not Impact on Outcome in Patients with Hodgkin Lymphoma Treated with ABVD Chemotherapy in the HAART Era,

Abstract 3646 Background:The prognosis of patients with HIV and non-Hodgkin lymphoma (NHL) has improved considerably since the advent of HAART, approaching that of patients with NHL in the general population when treated with the same chemotherapy regimens. However, it is not clear whether the same holds true for patients with Hodgkin lymphoma (HL). Aim: To analyze the outcome of patients diagnosed with HL treated with ABVD in the HAART era according to HIV status. Patients: From 1997 to 2010, 237 patients (92 with HIV infection) were newly diagnosed with HL at 5 university hospitals in London and consecutively treated with ABVD chemotherapy. Patients with HIV were older (median age: 41 years vs 31, p<0.001) and more were men (88% vs 59%, p<0.001). The histology subtype was more frequently mixed cellularity in HIV patients (54%) than in non-HIV (19%, p<0.001). In addition, HIV positive patients had more advanced stage at diagnosis (stage III-IV: 80% vs 33%, p<0.001), B-symptoms (81% vs 36%, p<0.001), lower Hb level (<10.5g/dL: 46% vs 20%, p<0.001) and lower albumin level (<4g/dL: 76% vs 35%, p<0.001). Patients with HIV infection had more frequently high risk disease according to the International Prognostic Score than HIV negative patients (IPS>3: 71% vs 22%, p<0.001). Amongst HIV patients, the HIV viral load (VL) was undetectable at the time of HL diagnosis in 52 of 86 patients with available data. The median VL for the remainder was 4,563 (range: 3,060–6,066). Forty-seven patients (53%) had a CD4 count <200/mL. All patients were treated with 4–6 cycles of ABVD chemotherapy with or without radiotherapy to residual/bulky areas according to local policies. Ninety patients with HIV infection received HAART concomitantly during chemotherapy. Results: The complete response (CR) rate in HIV positive and negative patients was 74% and 81%, respectively (p=NS). Fifty-one patients (21%) received consolidation radiotherapy. After a median follow-up of 59 months (range: 8–172 months), 40 patients relapsed at a median time of 7 months (range: 1–106). The median duration of response for HIV positive and negative patients was 33 months and 48 months, respectively (p=NS). Thirty-three patients have died: in 25 cases of HL; 2 patients due to toxicity and 5 patients due to other causes. Five-year event-free survival (EFS) was 59% (95%CI: 46–69) for HIV patients and 65% (95%CI: 56–72) for the remainder (p=NS). Five-year overall survival (OS) was 79% (95%CI: 67–87) and 88% (95%CI: 80–92) for HIV positive and negative patients respectively (p=0.06). HIV status did not predict OS or EFS on multivariate analysis including all variables comprising the IPS and HIV status. Conclusions: This long follow-up study demonstrates that patients diagnosed with HL in the setting of HIV infection have a more extensive disease with adverse prognostic factors. However, when treated with ABVD chemotherapy HIV positive status does not adversely affect OS or EFS. Disclosures:Montoto:Roche: Honoraria; Genentech: Research Funding. Orkin:Janssen: Honoraria; Gilead: Honoraria; BMS: Honoraria; BI: Honoraria; MSD: Honoraria; GSK: Honoraria; Viiv: Honoraria. Gribben:Roche: Honoraria; Celgene: Honoraria; GSK: Honoraria; Mundipharma: Honoraria; Gilead: Honoraria; Pharmacyclics: Honoraria.

HIV-Associated Plasmablastic Lymphoma: A Multi-Institutional Study

Abstract 1589 Background:Plasmablastic lymphoma (PBL) is a distinct subtype of B-cell lymphoma strongly associated with HIV infection with no more than 150 cases reported in the literature. We conducted a retrospective study to evaluate clinicopathological characteristics and determine prognostic factors in HIV-associated PBL (HIV PBL). Methods:Institutions in the United States (US) and internationally submitted clinical and pathological patient-level data on HIV-positive individuals who had a pathological diagnosis of PBL. According to WHO criteria, all the cases were required to have a plasmablastic morphology, be CD20-negative and to express at least one plasmacytic marker (i.e. CD38, CD138 and/or MUM1/IRF4). Continuous and categorical variables are presented using descriptive statistics. Univariate survival analyses were performed using the Kaplan-Meier method and the log-rank test. Cox proportional-hazard regression test was used for the multivariate survival analysis. P-values of less than 0.05 were considered statistically significant. Results:Thus far, data on 45 patients have been obtained from 11 institutions. Twenty cases (44%) were from Europe, 17 (38%) from the US, 4 (9%) from Africa and 4 (9%) from South America. The median age was 43 years (range: 19–66 years). Of 45 patients studied, 78% (n=35) were men. The median CD4+ count was 177 cells/mm3 (range: 17–683 cells/mm3). The median duration of HIV infection prior to PBL diagnosis was 6 years (range 0–26 years), and 80% (n=36) received HAART. PBL was the initial presentation of HIV infection in 29% (n=13) of the patients. The median viral load at presentation was 45,000 copies/ml (range: undetectable to 4.7 million copies/ml). At presentation, 69% (n=25) of patients exhibited B symptoms, 44% (n=20) had extranodal involvement, 65% (n=28) presented with stage III or IV disease, 20% (n=9) had oral involvement and 39% (n=12) had an absolute lymphocyte count (ALC) <1000 cells/mm3. EBV-encoded RNA was expressed in 94% (n=31), Ki67 >90% was seen in 66% (n=21) and MYC rearrangement was detected in 50% (n=10) of tested patients. Chemotherapy was employed in 89% (n=39) of patients, with 59% (n=23) receiving CHOP. A minority (n=4; 10%) underwent HSCT. Complete response (CR) was obtained in 69% (n=22); however, after 48 months of follow-up, 66% of patients (n=29) have died. The median overall survival (OS) was 11 months (95% CI 7–20 months) from diagnosis. The most common cause of death was PBL progression (n=18; 62%). At the univariate level, adverse prognostic factors for survival included non-CR to chemotherapy (p =0.002), ALC <1000 cells/mm3 (p =0.006), MYC rearrangement (p =0.0005), ECOG performance status >1 (p =0.048), female sex (p =0.02), and advanced stage (p =0.047). At the multivariate level, ALC <1000 cells/mm3 and non-CR were independent adverse prognostic factors in patients with HIV PBL (p =0.01 and p =0.02, respectively). Conclusions:PBL is a rare aggressive B-cell lymphoma, which tends to affect young HIV-positive men who have CD4+ counts <200 cells/mm3. Advanced stage, extranodal involvement, and tumors with EBER expression, MYC rearrangements and Ki67 >90% at presentation are common features of HIV PBL. Although showing a 69% CR to chemotherapy, the median OS remains poor at 11 months. In the multivariate survival analysis, ALC <1000 cells/mm3 and lack of achievement of CR to chemotherapy were independent adverse prognostic factors in HIV PBL. In the HAART era, HIV PBL seems to have a shorter median OS than other HIV-associated aggressive B-cell lymphomas. Disclosures:Montoto:Genentech: Research Funding; Roche: Honoraria. Vose:GSK: Research Funding; Millenium: Research Funding; Celgene: Research Funding; BMS: Research Funding; Exelixis: Research Funding; SBio: Research Funding; Pharmacyclics: Research Funding; Genentech: Research Funding. Castillo:GlaxoSmithKline: Research Funding; MIllennium Pharmaceuticals: Research Funding.