Improved Survival in Patients with AIDS-related Lymphomas (ARL)

By Dr Lim Soon Thye, Associate Consultant
Dept of Medical Oncology, NCC

Patients who are infected with the Human Immunodeficiency Virus (HIV) are at an increased risk for developing AIDS-related lymphomas (ARL). In the past, the average survival of these patients was very poor, usually about 6 months. Many of them have very poor immunity and developed serious complications when treated with full doses of chemotherapy. Thus, these patients were generally treated with reduced doses of chemotherapy, unlike patients who are not HIV infected.

Over the last 10 years, researchers have developed very effective drugs against HIV infection, called Highly Active Antiretroviral Therapy (HAART). With the increasing use of HAART, one large study in the United States showed that death due to complications arising from HIV infection has decreased by more than 70%.

Recently, researchers from the National Cancer Center (NCC) here as well as their counterparts from the University of Southern California (USC) have similarly found that the survival of patients with ARL has also improved dramatically. Using data from almost 400 ARL patients treated over a period of 25 years, researchers found that the duration of survival was an average of 8 months (before HAART was available between 1992 to 1996) to an average of more than 40 months when HAART was available (from 1997-2004) and is routinely used. In fact, the survival of patients with ARL treated with both chemotherapy and HAART is now very similar to that of non-HIV infected patients with lymphomas.

Researchers also found that a low CD4 (white blood cells) count predicted for an increased risk of death among patients who were not treated with HAART. The CD4 count measures the strength of a patient’s immunity. Thus, with the use of HAART, patients with ARL are now less likely to die as a result of their low immunity status.

These findings are important as they suggest that the behavior and outcomes of HIV-infected patients with lymphomas are now very similar to those of non-HIV infected patients. As such, these patients should now be treated with similar measures currently used for patients without HIV infection.