HIV-Related Burkitt’s NHL (BL) vs. Diffuse Large-Cell NHL (DLCL) in the Pre- and HAART Eras: Significant Differences in Survival with Standard Chemotherapy.

Background: The survival of patients with HIV-related NHL has significantly improved by the widespread use of HAART. However, the survival of patients with HIV-BL treated with standard chemotherapy regimens remains poor.

Methods: In order to evaluate the outcome of patients with HIV-BL in comparison to that of patients with HIV-DLCL, we reviewed our series of 253 HIV-NHL diagnosed and treated at the National Cancer Institute of Aviano, Italy from 1984 to 2003, including 125 cases in the pre-HAART era (77 HIV-DLCL and 48 HIV-BL) and in the HAART era (93 HIV-DLCL and 35 HIV-BL).

Results: All patients both with HIV-DLCL and HIV-BL were treated with the same doxorubicin containing chemotherapy regimens. The median OS of all patients was significant longer in the HAART era in comparison to that of the pre-HAART era (15 vs 8 months, p ≤ 0.0001). In addition, in the pre-HAART era, the median OS was similar in patients with HIV-BL vs patients with HIV-DLCL (7 vs 10 months, p = 0.11) whereas in the HAART era the median OS of patients with HIV-BL was significantly shorter than that of patients with HIV-DLCL (8 vs 22 months).

Conclusions: Our data confirm that the significant improvement of the outcome of patients with HIV-NHL is related to the positive impact of HAART on the survival of patients with HIV-DLCL whereas the prognosis of HIV-BL remains poor despite the use of HAART. Taking into consideration that in the HAART era patients with HIV infection are likely to tolerate intensive chemotherapy regimens, a more intensive approach similar to that employed in the general population should be employed also in patients with HIV-BL.