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AIDS (acquired immunodeficiency syndrome) is a disease caused by the human immunodeficiency virus (HIV). This virus attacks and weakens the immune system, so a person with AIDS can’t fight infections or diseases. People with AIDS have a greater risk for developing infections and certain cancers, like lymphoma.
Non-Hodgkin lymphoma (NHL) is the most common lymphoma that affects people with AIDS. NHL in people with AIDS is called AIDS-related lymphoma. It occurs in about 4–10% of people with AIDS. The number of people who develop AIDS-related lymphoma has decreased since highly active antiretroviral therapy (HAART) drugs have been used to treat HIV infection.
AIDS-related lymphoma starts in the lymphatic system. It is often aggressive and tends to grow and spread quickly. People with AIDS-related lymphoma are often at an advanced stage when they are diagnosed. The bone marrow, brain and spinal cord (central nervous system) and gastrointestinalgastrointestinalReferring to or having to do with the digestive organs, particularly the stomach, small intestine and large intestine. tract are often affected.
AIDS-related lymphomas are usually B-cell types of lymphomas. The main types include:
Some factors that affect the prognosis of people with AIDS-related lymphoma are:
Treating AIDS-related lymphoma is usually a combination of treating the lymphoma and treating AIDS. Generally, an AIDS-related lymphoma is harder to treat than a lymphoma not related to AIDS.
Different treatments and combinations of treatment may be used to treat AIDS-related lymphoma.
Highly active antiretroviral therapy (HAART) is used to slow down the progression of AIDS. People with AIDS have weakened immune systems and cancer treatment can cause more problems. As a result, people with AIDS-related lymphoma are sometimes treated with lower doses of chemotherapy drugs than people with lymphoma who do not have AIDS.
Treatment with HAART may allow some people with AIDS-related lymphoma to safely receive combinations of chemotherapy drugs in standard or even higher doses. When colony-stimulating (hematopoietic) growth factors are added to chemotherapy, people can tolerate treatment better.
Combinations of chemotherapy drugs, which are used to treat other aggressive B-cell types of lymphoma, are often used to treat AIDS-related lymphoma. Some of these combinations include CHOP or CHOP-like therapies.
The use of monoclonal antibodies, such as rituximab (Rituxan), is not well-defined in AIDS-related lymphomas because of the increased risk of infection in people with AIDS. However, it may be used in combination with chemotherapy in people with high enough CD4 counts.
Drugs, such as antibiotics, are also used to prevent and treat infections.
Colony-stimulating factors (CSFs) are used to stimulate the bone marrow to produce more of certain blood cells. This helps reduce the risk of infection, anemia and bleeding because of low blood counts associated with chemotherapy.
People with AIDS-related lymphoma have a high risk of their lymphoma spreading to the central nervous system (CNS). CNS prophylaxis is used to try to prevent cancer cells from entering the tissue covering the brain and spinal cord. CNS prophylaxis may involve giving intrathecal chemotherapy (chemotherapy drugs are injected into the cerebrospinal fluid).
AIDS-related primary central nervous system (CNS) lymphoma is often treated with external beam radiation therapy to the entire brain (whole-brain radiation therapy or WBRT).
For more detailed information on specific drugs, go to sources of drug information.
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.