Predictors Of Aidsrelated Lymphoma

Genetic, infectious, and immunologic factors influence the development of AIDS-related lymphoma. For example, germline chemokine and chemokine receptor gene variants have been found to influence the chance of developing these tumors.1819 Acyclovir has mild activity against Epstein-Barr in vivo, and one case-control study has shown that administration of high-dose acyclovir (>800 mg/day) for >1 year was associated with a significant reduction in the incidence of NHL.20

An analysis of a cohort of over 8000 HIV-positive patients has identified three factors in multivariate analysis that are significantly associated with the development of NHL: age, nadir CD4 cell count, and no prior HAART.21 As the CD4 count falls, the development of lymphoma becomes more likely, and this may explain the declining incidence of NHL since the introduction of HAART, as it is thought that the immune restoration that accompanies HAART protects against the development of AIDS-related lymphoma. Nonetheless, the risk of lymphoma persists even among patients who are on HAART and have no detectable HIV viremia.22

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