Background: HIV-related Non-Hodgkin's Lymphoma (HIV-NHL) has been usually associated with a lower complete response (CR) rate, higher relapse rate and shorter overall survival (OS) in comparison to high grade NHL of the general population.

Methods: From January 1997 (when HAART was introduced in our clinical practice) to April 2002, 329 cases of high grade NHL (110 in HIV⁺ patients (pts) and 219 in the general population) were diagnosed and treated (with comparable adriamycin-based chemotherapy (CT) , and with HAART during and after CT in pts with HIV-NHL) at the National Cancer Institute of Aviano, Italy, by the same group of onco-hematologists. Taking in consideration the lower age of pts with HIV-NHL, only pts under 50 yrs of age (100 in HIV⁺ group and 82 in HIV^- group) are the object of this study.

Results: The most important statistically significant differences observed in the 2 groups are reported in the table.

 

Pts characteristics and outcome	HIV-pos	HIV-neg	p =
Male sex	79 %	54 %	0.0003
Histology: Diffuse large cell	61 %	91 %
Burkitt	25 %	6 %
Others	14 %	3 %	<0.0001
Stage III + IV	77 %	58 %	0.006
Bulky	30 %	46 %	0.03
Extranodal disease	81 %	69 %	0.04
Gastrointestinal tract	28 %	9 %	0.0009
LDH > Normal value	67 %	51 %	0.03
Albumin < Normal value	68 %	43 %	0.001
CR rate	51 %	74 %	0.007
Relapse rate	26 %	24 %	0.75
OS at 3 years	37 %	74 %	<0.0001
Response adjusted OS: Hazard Ratio (HR): 1.40	HR: 1	0.24

 

Conclusion: Our data show that the overall prognosis of pts with HIV-NHL is worse than that of the general population, mainly because to the unfavorable prognostic factors at presentation and underlying HIV. However when CR is achieved, relapse rate and response adjusted OS are super-implosable to that of the general population. In the HAART era, we have shown for the first time that pts with HIV-NHL who achieve a CR with CT and on HAART have the same outcome as pts with high grade NHL of the general population.