Volume 4, Number 6; July 13, 2005
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Volume 4, Number 6; July 13, 2005 |
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55-year-old African-American male with AIDS and swollen, discolored eye.
Recommended reading:
Epidemiology of non-Hodgkin lymphomas and other haemolymphopoietic neoplasms in people with AIDS.
Etiology and pathogenesis of AIDS-related non-Hodgkin's lymphoma.
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Patient: A 55 year old African American male with AIDS, CD4 = 135, HIV since 1996, history of HepC, polysubstance abuse (no IVDA), PCP, syphilis, TB. Presents with left lower back pain, groin pain, intermittent stomach swelling, chronic cough, weight loss, and swollen and skin-discolored left eye past 3 days.
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Session Handout: <15> Link Directly to Fulltext Article at Science Direct Unique Identifier [PMID]: 12573353 Authors: Dal Maso L. Franceschi S. Institution: Servizio di Epidemiologia e Biostatistica, Centro di Riferimento Oncologico, IRCCS, Aviano, PN, Italy. epidemiology@cro.it Title: Epidemiology of non-Hodgkin lymphomas and other haemolymphopoietic neoplasms in people with AIDS. [Review] [73 refs]
Source: Lancet Oncology. 4(2):110-9, 2003 Feb. Abstract: HIV-infected individuals have a high risk of developing non-Hodgkin lymphoma (NHL). In Europe, the prevalence of AIDS with a concurrent NHL diagnosis increased from 3.6% to 5.4% between 1994 and 2000. In population-based record linkages between cancer registries and AIDS registries in the USA, Italy, and Australia, the relative risks of NHL in people with AIDS ranged between 15 for low-grade and T-cell NHL and 400 for high-grade NHL. The corresponding relative risk of Hodgkin's disease was about 10, whereas the risks for multiple myeloma and leukaemias were in the range 2 to 5. Since the introduction of highly active antiretroviral therapy in the more developed countries (1996), most studies have suggested a decline in the incidence of some types of NHL, most notably the primary brain form. In studies from Africa, the risk of HIV-associated NHL is about ten times less than that in the more developed countries, but underascertainment and earlier death from other AIDS-related illnesses may explain the relative lack of HIV-associated lymphomas. [References: 73] Publication Type: Journal Article. Review. Review, Tutorial.
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Clinical Question: 1) What are current aspects of AIDS-related lymphoma, especially non-Hodgkin's lymphoma in HIV patients?
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Readings:
<6> Fulltext Available in EBSCOHost Academic Search Premier Unique Identifier [PMID]: 15202527 Authors: Little RF. Institution: HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, Bldg 10, Room 10S255, 9000 Rockville Pike, Bethesda, MD 20892-1868, USA. rlittle@helix.nih.gov Title: AIDS-related non-Hodgkin's lymphoma: etiology, epidemiology, and impact of highly active antiretroviral therapy. [Review] [57 refs]
Source: Leukemia & Lymphoma. 44 Suppl 3:S63-8, 2003. Abstract: Lymphoproliferative disorders (LPD) occur more frequently in the immunosuppressed host compared to those who are immunocompetent. The biological and clinical characteristics of a particular LPD are specific to the underlying immune defect, though there are clear similarities in the various tumor types that occur. Immunosuppression-related LPD are more frequently associated with gamma-herpesviruses suggesting that the immunologic environment influences tumorigenesis. Clinical outcomes may be optimized when appropriate treatment strategies are based on consideration of the underlying immunodeficiency and on the tumor biology. Consistent with this observation, in AIDS-related lymphomas (ARL), tumor biology, clinical presentations, and treatment outcomes are correlated with the CD4 cell count. This review will consider the role of immune deficiency in HIV disease on ARL pathogenesis and epidemiology, and the impact that highly active antiretroviral therapy has had in this disease. [References: 57] Publication Type: Journal Article. Review. Review, Tutorial.
<14> Fulltext Available in MDConsult using Journal Search and the search term: 12852656 Unique Identifier [PMID]: 12852656 Authors: Knowles DM. Institution: Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA. dknowles@med.cornell.edu Title: Etiology and pathogenesis of AIDS-related non-Hodgkin's lymphoma. [Review] [203 refs]
Source: Hematology - Oncology Clinics of North America. 17(3):785-820, 2003 Jun. Abstract: The incidence of NHL is greatly increased in HIV-infected individuals; malignant lymphoma is the second most common neoplasm that occurs in association with AIDS. The vast majority of neoplasms are clinically aggressive, monoclonal B-cell neoplasms that exhibit Burkitt's, immunoblastic, large cell, or transitional histopathology. Approximately 80% arise systemically (nodal or extranodal) and 20% arise as primary CNS lymphomas. A small proportion of neoplasms are body cavity-based, primary effusion lymphomas that are uniquely associated with KSHV infection. Recently, HIV-associated polymorphic lymphoproliferative disorders have been described as well. AIDS-related NHLs appear to exhibit distinctive clinical characteristics according to their histopathology and anatomic site of origin. Factors that contribute to lymphoma development include HIV-induced immunosuppression, impaired immune surveillance, cytokine release and deregulation, and chronic antigenic stimulation. This environment is associated with the development of oligoclonal B-cell expansions. The appearance of NHL is characterized by the presence of a monoclonal B-cell population that displays a variety of genetic lesions, including, for example, EBV infection, MYC gene rearrangement, BCL6 gene rearrangement, P53 mutations and deletions, and RAS gene mutations. The number and type of genetic lesions vary somewhat among AIDS-related NHLs according to their histopathologic category and anatomic site of origin. These findings suggest that more than one pathogenetic mechanism is operational in the development and progression of AIDS-related NHLs. Further work is necessary to develop a complete understanding of the etiology and pathogenesis of NHL in the setting of HIV infection. AIDS-related NHL is an important biologic model for investigating the development and progression of high-grade NHLs and NHLs that develop in immunedeficient hosts. [References: 203] Publication Type: Journal Article. Review. Review, Tutorial.
<16> Link Directly to Fulltext Article at Publisher Unique Identifier [PMID]: 12525676 Authors: Scadden DT. Institution: AIDS Research Center and Cancer Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Room 5212, Boston, Massachussetts 02129, USA. scadden.david@mgh.harvard.edu Title: AIDS-related malignancies. [Review] [135 refs]
Source: Annual Review of Medicine. 54:285-303, 2003. Abstract: Immunodeficiency alters the risk of cancer. Specific types of immune dysfunction are associated with different tumor risks, but most tumors are related to oncogenic viruses. In acquired immunodeficiency due to the human immunodeficiency virus (HIV), HIV itself rarely directly causes cancer; rather, it provides the immunologic background against which other viruses can escape immune control and induce tumors. The most common malignancies are Kaposi's sarcoma and non-Hodgkin's lymphoma. This chapter discusses the pathophysiologic background of these tumors, how they have been affected by the use of anti-HIV medications, and their clinical management. [References: 135] Publication Type: Journal Article. Review.
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Resident Report / Department of Medicine & Grady Branch Library Emory University School of Medicine 2005 Edition Participating Faculty: Carlos Del Rio MD / Joyce Doyle MD / Lorenzo Difrancesco MD / Erich Folch MD / Alicia Hidron MD
Contact:
Karl Woodworth
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