AIDS research and human retroviruses 2017 05 26() doi 10.1089/AID.2017.0081
Given scarce data from sub-Saharan Africa (SSA), we sought to describe CD4 count and HIV RNA trends over time among patients with HIV+ lymphoproliferative disorders in Malawi.
We prospectively enrolled HIV+ individuals with pathologically confirmed lymphoproliferative disorders between 2013 and 2016. Chemotherapy was standardized with concurrent antiretroviral therapy (ART). We assessed CD4 count and HIV RNA at baseline and every 6 months for up to 2 years.
Of 72 HIV+ patients, 59 had non-Hodgkin lymphoma (NHL), 5 classical Hodgkin lymphoma (CHL), and 8 multicentric Castleman disease (MCD). Median age was 43 years (range 23-64). Fifty-five patients (76%) were on ART at enrollment for a median 47 months (range 1-387), with median CD4 count 138 cells/μL (range 2-2,235) and median HIV RNA 2.2 log10copies/mL (range 0.3-7.3). MCD patients had longer median ART durations, higher median CD4 counts, and lower median HIV RNA at baseline than NHL or CHL. CD4 count and HIV RNA steadily improved during follow-up, with different patterns in different histologic groups. Twelve-month overall survival (OS) was 55% [95% confidence interval (CI) 42-66%]. There were trends toward baseline CD4 count <100 cells/μL and HIV RNA >2.0 log10copies/mL being associated with worse OS. However, CD4 count and HIV RNA improvements during follow-up were independent of possible effects on OS.
Distribution of HIV+ lymphoproliferative disorders may change with continued ART scale-up in SSA. Chemotherapy and concurrent ART can lead to good immunologic and virologic outcomes.