Background:  The aim of this study is to analyze current characteristics and outcome of AIDS-related lymphoma patients according to risk factors, use of specific poly-chemotherapy and ART.

Methods:  This prospective observational study includes all patients with HIV-associated non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL) diagnosed since January 2005 in 20 participating centres. After enrolment, patients are followed every 6 months.

Results:  As of October 2007, 143 patients (123 NHL, 20 HL) had been included. At the time of AIDS-related lymphoma diagnosis, 45% had prior ART exposure, and 24% had a viral load <50 copies/mL. Proportions differed significantly between NHL and HL (prior ART, 36% vs 85%, p <0.0001; viral load >50 copies/mL, 18% vs 55%, p <0.001). Rates of complete remission were 91% in HL and 66% in NHL (p = 0.15), and overall survival did not significantly differ between the 2 entities (p = 0.16). After a median follow-up of 6.0 months, 37 patients (34 NHL, 3 HL) had died. In patients with NHL, 73% received a CHOP-based poly-chemotherapy while 19% received an intensified protocol adapted from the German study group for adult acute lymphoblastic leukemia. Rituximab was added to poly-chemotherapy in 55% of the NHL patients (median CD4 cell count: 220/µL vs 147/µL in patients without rituximab). Complete remission was achieved in 71% compared to 57% in patients without rituximab (p = 0.18). A baseline CD4 cell count of >100/L (p = 0.04), a low IPI score (p = 0.04), no prior ART exposure (p = 0.04), and the use of rituximab (p = 0.007) were significantly associated with better overall survival. Use of rituximab was associated with better overall survival even in patients with a baseline CD4 cell count of <100/µL (p = 0.048). In total, there were 8 deaths from infections (7 NHL, 1 HL), which were not related to specific poly-chemotherapy regimens, use of rituximab or to other factors. 

Conclusions:  Whereas the majority of NHL cases was diagnosed in ART-naïve patients, HL mainly occurred in patients with controlled viremia during ART. In NHL patients, overall survival was better with rituximab even in severely immunosuppressed patients. Confounding factors (i.e. CD20 expression of lymphoma) may have contributed to these results. However, our data indicate that treatment with rituximab is not associated with increased mortality from infection in patients with AIDS-related lymphoma. The high early mortality rate underlines the need for intensive efforts to improve the outcome of these patients.