infectious diseases
Cancers Common in Patients with HIV Infection
Primary central nervous system lymphoma
Incidence of Primary Brain Lymphomas is markedly increased in patients infected with HIV with very low CD4 counts. Primary central nervous system lymphomas consist of intermediate- or high-grade malignant B cells, originating in central nervous system tissue. These lymphomas do not spread systemically, but the prognosis is poor; median survival is < 6 months. Presenting symptoms include headache, seizures, neurologic deficits (eg, cranial nerve palsies), and mental status changes. Acute treatmentof primary central nervous system lymphomas requires control of cerebral edema using corticosteroids. Although whole-brain radiation therapy and antitumor chemotherapy with high-dosemethotrexatealone or combined with other chemotherapy drugs orrituximabare commonly used, none of these regimens has been rigorously evaluated. In observational studies of ART and in a single clinical trial ofrituximab, survival appeared improved. 