HAART Ups Survival in Primary CNS Lymphoma Patients

CHICAGO—Highly active anti-retroviral therapy (HAART) has drastically reduced the incidence of primary central nervous system (CNS) lymphoma in HIV-positive individuals at a French hospital and improved survival in HIV-positive patients who have the brain malignancy.

A poster presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC abstract 250) traced patients with primary CNS lymphoma over a 17-year period.

Only eight cases of the disease have occurred since HAART was introduced in 1996, said Phillippe Bossi, MD, of Pitie-Salpetriere Hospital. Median survival, which was only 1 month prior to the introduction of HAART, increased to 10 months between 1996 and 1999, he said.

The poster presented findings from a retrospective analysis of 80 patients with primary CNS lymphoma out of a total of 2,263 individuals with AIDS who were followed from 1983 to 1999 at Pitie-Salpetriere Hospital. Between 1988 and 1991, the incidence of primary CNS lymphoma rose steadily, reaching a peak of 39 per 1,000 patient-years. The incidence has declined since 1991, dropping to 1.9 per 1,000 patient-years in 1999.

In 29 patients (36%), primary CNS lymphoma was the first indication of AIDS. The vast majority of patients were male (92%). A total of 66 patients (82%) received HAART.

Median survival increased in particular for patients who had high CD4+ cell counts at the time primary CNS lymphoma was diagnosed. Of the 8 patients diagnosed since 1996, four lived less than 5 months after diagnosis. These patients had CD4+ cell counts ranging from 1 to 4/µL at diagnosis, and the count did not change from diagnosis to death.

In contrast, the other four patients, with median CD4+ cell counts of 95/µL, lived longer than 15 months, and their cell counts had increased to 241/µL at the time of their death or the last measurement. Two of these patients were still alive 38 and 44 months after diagnosis and use of HAART.

The authors pointed out that primary CNS lymphoma is the most common brain malignancy in individuals infected with HIV who have low CD4+ cell counts (below 50/µL) and that the disease is associated with the Epstein-Barr virus (EBV). The authors suggested that HAART might restore the ability of the immune system to suppress B cells in the central nervous system that have been immortalized with EBV.