infectious diseases
Cancers Common in Patients with HIV Infection
Non Hodgkin lymphoma
Incidence of Non-Hodgkin Lymphomas is 50 to 200 times higher in patients infected with HIV. Most cases are B-cell, aggressive, high-grade histologic subtype lymphomas. At diagnosis, extranodal sites are usually involved; they include bone marrow, gastrointestinal tract, and other sites that are unusual in non–HIV-associated non-Hodgkin lymphoma, such as the central nervous system and body cavities (eg, pleural, pericardial, peritoneal). Common presentations include rapidly enlarging lymph nodes or extranodal masses and systemic symptoms (eg, weight loss, night sweats, fevers). Diagnosisof non-Hodgkin lymphoma is by biopsy with histopathologic and immunochemical analysis of tumor cells. Abnormal circulating lymphocytes or unexpected cytopenias suggest involvement of the bone marrow, mandating bone marrow biopsy. Tumor staging may require cerebrospinal fluid examination and CT or MRI of the chest, abdomen, and other areas where tumors are suspected. Poorprognosisis predicted by the following: CD4 count of<100/mcL Age>35 years Poor functional status Bone marrow involvement History of opportunistic infections High-grade histologic subtype Treatmentof non-Hodgkin lymphoma is with various regimens of systemic, multidrug chemotherapy that includescyclophosphamide,doxorubicin,vincristine,prednisone, andetoposide. These drugs are combined with IVrituximaband an anti-CD20 monoclonal antibody and supplemented with antiretroviral therapy (ART), prophylactic antibiotics and antifungals, and hematologic growth factors. Therapy may be limited by severe myelosuppression, particularly when combinations of myelosuppressive antitumor or antiretroviral drugs are used. Radiation therapy may debulk large tumors and control pain or bleeding. 