What is it about?

People living with HIV are more likely to develop tumors of the lymph glands or AIDS Related lymphomas. South Africa has the highest number of people living with HIV, and 18% of the population in KwaZulu-Natal (a province in South Africa) live with HIV. This study looked at 102 patients with AIDS Related lymphoma over 10 years (2006-2016), and found that after 4 years, half of the patients were still alive. Male patients, and patients who cleared all signs of the lymphoma i.e. achieved a remission or complete response, were more likely to be alive at 4 years. Patients with better control of HIV were more likely to respond to chemotherapy. Patients who had been given 6 or more cycles of chemotherapy were also more likely to be alive at the 4-year time period. The medical prognostic systems for lymphoma are called the International Prognostic Index (IPI) or the age-adjusted IPI. These scoring systems were able to reliably predict which patients would survive the 4 years. These prognostic systems look at the patient's age (< or > 60 years), how far the lymphoma has spread (stage), where the lymphoma is in the body (in the lymph glands or out of the lymph glands), how functional the patient is in the normal day-to-day activities (performance status) and certain blood levels results. The study was able to prove that these scoring systems have value for determining what the prognosis is for patients with HIV and lymphoma.

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Why is it important?

Our study shows that patients with good control of HIV, completing the full course of chemotherapy have reasonable survival at 4 years. The study proves the usefulness of the IPI. To our knowledge, this is the first such study from the province of KwaZulu-Natal.

Perspectives

It is good to document objectively, that despite the socio-economic restrictions in South Africa, 50% of the patients were alive after 4 years. We do not practice routine CNS prophylaxis, and patient outcomes with this very practical approach were acceptable. Further prospective studies are needed to assess: Incidence of marrow involvement, value of CD20 monoclonal antibodies and optimal management of CNS prophylaxis.

Dr Nadine Rapiti
University of KwaZulu-Natal

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This page is a summary of: Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa, PLoS ONE, September 2022, PLOS,
DOI: 10.1371/journal.pone.0272282.
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