Combining aggressive HIV therapy and chemotherapy significantly improves the survival rates of HIV-positive men and women treated for lymphoma.

A study reveals that combination therapy showed the greatest benefit for HIV patients suffering from aggressive malignant non-Hodgkin's lymphoma.
This benefit was most pronounced in HIV patients without severely impaired immune functions. These so-called "standard risk" patients responded as well to therapy and survived as long as lymphoma patients without HIV.

Lymphomas are treated with chemotherapy, often consisting of a multi-drug regimen using Cyclophosphamide, Doxorubicin, Vincristine and Prednisone ( CHOP ).
People with HIV, a virus that depletes integral, specialized white cells called CD-4 cells, are at increased risk of developing lymphomas, particularly aggressive, fast-growing non-Hodgkin type lymphomas. These are called " AIDS-related lymphomas " ( ARL ) and generally have a poorer prognosis than non-HIV-related lymphomas.
Highly active antiretroviral therapy ( HAART ) revolutionized care of HIV-positive men and women. It not only improves laboratory indicators, such as increased CD-4 cells and reduced viral loads, but also significantly improves survival and delays the onset of AIDS and AIDS-related cancers, including lymphomas.

With the lack of study data to show the efficacy of maintaining HIV-positive patients on HAART while they are treated with chemotherapy for AIDS-related lymphoma, oncologists are hesitant to expose HIV patients to hypothetical drug toxicities related to combining the therapies.

Researchers, led by Rudolf Weiss, treated 72 HIV-patients with AIDS-related lymphoma divided into high-risk and standard-risk cohorts with combined CHOP and HAART to evaluate the safety and efficacy of the combined regimen.

The investigators found combined therapy improved survival rates for patients with AIDS-related lymphoma and standard level of risk to rates comparable to those in non-HIV patients with lymphoma treated with CHOP and superior to previously published rates achieved by CHOP alone.

For standard-risk AIDS-related lymphomas patients 79 percent achieved complete remission, and after 47 months of follow-up and study's end, more than 50 percent of patients survived. Moreover, only 40 percent reported moderate drug toxicity.
For high-risk AIDS-related lymphoma patients, only 29 percent achieved complete remission and median survival was only 7.2 months. Sixty-nine percent reported moderate toxicity.

" The present study showed that our risk-adapted strategy for concomitant administration of HAART with CHOP is effective and safe," the authors concluded.

Source: Cancer, 2006


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