A Review of HIV Related Burkitt's Lymphoma/Leukemia in Sub Saharan Africa.

Burkitt's malignancies have increased substantially in frequency In HIV infected patients regardless of CD4 count. There is limited information about the clinical presentation and outcome of adult HIV+ patients with Burkitt's malignancies (BM) outside the endemic areas of Africa.

Patients with histologically confirmed BM were treated with antiretroviral medication and intense, anthracycline containing combinations (HyperC-VAD, COP-ADM). A retrospective review of the clinical characteristics and prognostic factors relevant for outcome was conducted comparing to an HIV –ve cohort.

Between 1999 and 2009, 32 HIV positive patients and 9 HIV negative individuals with Burkitt's malignancy were referred to a single centre. The median age was 33 (13-61) years, 19 were female; 18 patients had leukemia while 23 patients had Burkitt's lymphoma. Extranodal disease was seen in 16 patients, the presentation serum median LDH was 1902 (292-45100) i.u., CNS disease was present in 7. In the HIV+ population, the median presentation CD4 count was 193 (10-967)/uL, 18% were on HAART prior to diagnosis but in the majority the malignancy led to the initial presentation. Of the 32 HIV+ve subjects who received intense cytotoxic therapy, at median follow up of 261 (146-2564) days, 14 (44%) survive, 12 longer than 1 year. The main cause of death was disease progression, relapse (particularly in CNS) and opportunistic infections. Male gender (p= 0.02), nodal presentation (p= 0.01), higher Hb (p= 0.001) and platelets (p= 0.03) predicted for better outcome. Cox analysis confirmed that male gender (p= 0.03), lower LDH (p= 0.02), and nodal presentation (p=0.03) were independent factors for survival. Non parametric statistics showed that HIV-ve Burkitt's patients were predominantly male (p= 0.01), Caucasian (p= 0.02), had significantly higher presentation serum albumin (p= 0.01) and lower creatinine (p= 0.02). In the HIV-ve group 78% survive longer than 1 year (log Rank p= 0.01).

In South Africa there are distinct clinical differences between HIV+ve and negative patients who present with Burkitt's malignancies. While outcome in the HIV –ve population is favourable, it is significantly worse in the HIV+ve cohort. For this group, a different strategy is required to improve outcome.

No relevant conflicts of interest to declare.