Survival is prolonged by highly active antiretroviral therapy in AIDS patients with primary central nervous system lymphoma.

Authors

Skiest DJ, Crosby C 

Institution

The University of Texas Southwestern Medical Center, Division of Infectious Diseases, 5323 Harry Hines Blvd, Dallas, TX 75390-9113, USA.

Source

AIDS 2003 Aug 15; 17(12) :1787-93.

Abstract

OBJECTIVE
To determine the effects of highly active antiretroviral therapy (HAART) on survival in AIDS-related primary central nervous system lymphoma (PCNSL).
METHODS
Survival in consecutive patients with PCNSL at a large county teaching hospital from 1995 to 2001 were analyzed by the log rank test and Cox proportional hazards ratios (HR) were calculated for factors potentially affecting survival.
RESULTS
During the study period, 25 patients were diagnosed with PCNSL: 19 definite and 6 probable. At diagnosis, median CD4 cell count was 12 x 10(6) cells/l (range 1-151) and median HIV viral load was 5.3 log(10) copies/ml (range 3.9-5.9). Sixteen patients died (median survival 87 days; range, 0 to > 2112). Longer survival was noted for patients who received HAART after diagnosis [HR for death, 0.06; 95% confidence interval (CI), 0.01-0.48]. Six of seven HAART-treated patients were alive versus 0/18 untreated patients at a median follow-up time of 667 days (P = 0.0007 by log rank test). A survival benefit was seen for patients who had >/= 0.5 log(10) copies/ml decrease in HIV viral load after diagnosis (n = 6; HR, 0.07; 95% CI, 0.01-0.55) and for patients with a significant CD4 cell rebound (increase >/= 50 x 106 cells/l) in response to HAART (n = 6): all survived versus 0/19 survived (P = 0.0003). Cranial radiation therapy (n = 13) prolonged survival (HR, 0.20; 95% CI, 0.07-0.58). Median survival was only 29 days for 11 patients who received neither radiation nor HAART.
CONCLUSIONS
Receipt of HAART after diagnosis is associated with a significantly longer survival in patients with AIDS-related CNS lymphoma.

Mesh

Acquired Immunodeficiency Syndrome
Adult
Anti-HIV Agents
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
Central Nervous System Neoplasms
Female
Follow-Up Studies
Humans
Lymphoma, AIDS-Related
Male
Middle Aged
Proportional Hazards Models
Survival Rate
Viral Load

Language

eng

Pub Type(s)

Journal Article Research Support, U.S. Gov't, P.H.S.

PubMed ID

12891064