Over time, the spectrum of the
acquired immune deficiency syndrome (
AIDS) epidemic has changed, especially with the advent of
highly active antiretroviral therapy (
HAART). The goal of this article is to delineate changes occurring in the incidence and management of
lymphoma over the course of the
AIDS epidemic.
Lymphoma usually occurs rather late in the course of human immunodeficiency 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 for HIV and is more common in men than in women. It is usually diagnosed in patients with markedly decreased CD4 cell counts, consistent with prolonged periods 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 despite the recent widespread use of
HAART. While still somewhat controversial, use of
HAART has generally not produced a significant decline in the incidence 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 greater toxicity. Adapting
therapy to prognostic factors has not produced a significant improvement in survival. Use of antiretroviral
therapy along with
chemotherapy appears safe, and may be associated with longer survival. An infusional regimen called EPOCH (
etoposide,
prednisone,
vincristine [
Oncovin],
cyclophosphamide,
doxorubicin HCl) shows promise in the future management 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.