A retrospective study found that people with non-Hodgkin lymphoma who are HIV-positive and have not received antiretroviral therapy have similar outcomes with standard R-CHOP chemotherapy , compared to those who have already started their HIV treatment.
The study suggests that HIV-positive patients diagnosed with non-Hodgkin lymphoma should begin chemotherapy along with antiretroviral therapy as soon as possible.
The results were presented at the European Society for Medical Oncology (ESMO) Congress 2019, held from September 27 to October 7 in Barcelona, Spain, in a presentation entitled " Non-Hodgkin lymphoma in HIV-positive patients treated with antiretroviral therapy and chemotherapy: a single-institution retrospective study. "
People living with HIV have up to 25 times the risk of developing non-Hodgkin lymphoma compared to the general population. Those with lower CD4 counts and those who did not receive highly active antiretroviral therapy (HAART) have a particularly higher risk and a worse prognosis.
People can be diagnosed with non-Hodgkin lymphoma at the same time as their HIV diagnosis or some time after being diagnosed with HIV
Researchers in Italy conducted a retrospective study to compare the response to R-CHOP chemotherapy—standard chemotherapy containing rituximab , cyclophosphamide , doxorubicin , vincristine , and prednisone —between the two groups. All patients received ART along with chemotherapy.
The study included 46 patients, 11 treatment-naive and 35 treatment-experienced, who were similar in age, sex, lymphoma type, central nervous system involvement, frequency of B-cell symptoms , Coinfection with hepatitis. However, treatment-naive patients had more advanced lymphoma, with 91% metastasis compared to 41% of treatment-experienced patients.
At the start of treatment, half of the treatment-naive patients showed toxicity, compared to 10.7% of the experienced patients.
Treatment-naive patients often have higher viral loads, which "may explain their worse condition in terms of non-Hodgkin lymphoma at the time of diagnosis and toxicity during chemotherapy," the researchers wrote.
However, after one year of follow-up, the groups showed similar response rates (the percentage of patients who responded to total or partial treatment was 60% in treatment-naive patients and 62% in experienced patients).
The two groups showed a similar relative risk and life expectancy, an average of 67 months in the noave group versus 69.4 months in the experienced patients.
"The immediate initiation of HAART in combination with chemotherapy likely reduced the impact of immune status in terms of treatment response and survival," the researchers stated.
It is concluded that "treatment-naive patients should be treated with standard chemotherapy regimens, without modification of dose or schedule."