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The lifespan of people diagnosed with HIV has increased over the years and, as a result, malignancies have a larger contribution to morbidity and mortality in HIV-positive population. Compared with general population, HIV-positive population has an increased risk to develop lymphomas.
The improvement of survival in HIV-positive patients is the consequence of improved antiretroviral therapy, being more accessible and well tolerated, and the consequence of improved supportive strategies for these patients. Keywords HIV, lymphoma, cancer Rezumat Infecţia cu virusul imunodeficienţei umane HIV este asociată cu dereglări ale imunităţii celulare, care predispun la apariţia neoplaziilor, inclusiv a limfoamelor.
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Speranţa de viaţă a persoanelor diagnosticate cu HIV s-a îmbunătăţit de-a lungul anilor şi, ca urmare, neoplazia are o contribuţie crescută la morbiditatea şi mortalitatea populaţiei HIV-pozitive. Faţă de populaţia generală, pacienţii cu HIV prezintă un risc crescut de a dezvolta limfoame. Ameliorarea supravieţuirii la pacienţii HIV-pozitivi este consecinţa îmbunătăţirii terapiei antiretrovirale, fiind mai accesibilă şi bine tolerată şi, de asemenea, este consecinţa unor strategii de suport îmbunătăţite pentru aceşti pacienţi.
Cuvinte cheie HIV limfom cancer Introduction Human immunodeficiency virus HIV infection causes dysregulation of cell immunity, which predisposes to the development of cancer, including lymphomas 1,2.
The lifespan of people diagnosed with HIV has increased over the years and, as a result, malignancies have a larger contribution to morbidity and mortality in HIV-positive population. In HIV-positive population, the aggressive cancer lymphoma of Kaposi sarcoma, advanced aggressive cancer lymphoma cancer and of certain types of lymphomas, such as systemic high-grade B-cell non-Hodgkin lymphoma or primary central nervous system CNS lymphoma, is considered pathognomonic for acquired immunodeficiency syndrome AIDS.
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Other types of lymphomas, such as Hodgkin lymphoma or follicular lymphoma, are not considered AIDS-defining. The clinical presentation of lymphomas in HIV-positive population is different from lymphomas in HIV-negative patients 4,5.
Epidemiology Compared with the general population, HIV-positive population has an increased risk to develop lymphomas. For example, a meta-analysis that evaluated overpatients from 7 cancer registries demonstrated an increased risk from 23 to fold of lymphoma development in HIV-positive patients compared to the general population 6.
Another population-based study that includedHIV-positive patients for a period of 16 years, from toconducted in the United States, showed an increased risk of NHL, with a standardized incidence ratio of The incidence of Hodgkin lymphoma, comparing with non-Hodgkin lymphoma, was unchanged regardless ART use 9.
After the implementation of cART, the risk of Aggressive cancer lymphoma development decreased at first and remained stable over time, the decline being attributed to the improvements in CD4 counts 12, Specific HIV-related NHL, based on location, can be classified into three main categories: systemic NHL, primary central nervous system lymphoma, and primary effusion lymphoma.
The incidence of HL is 15 to 30 times higher than in the general population The relationship between HL and CD4 cell count is not really established, some studies indicating that severe immunosuppression is associated with HL, and others not finding any correlation between CD4 cell count and HL 20, The impact of cART on the incidence of HL is also unclear: some studies suggest that the incidence has increased in the cART era 22and others did not observe a significant change 21, Some authors state that the risk of HL may be increased especially in the first months after the initiation of cART 24, Table 1.
It is also observed that the risk aggressive cancer lymphoma lymphoma remains high even after the widespread use of cART, concluding that the relationship between the immunological state and lymphoma development is much more complex 27, Also, specific variants of HIV p17 have been found to be associated with the development of lymphoma The specific role aggressive cancer lymphoma oncogenic viruses — such as Epstein-Barr virus EBV and human herpesvirus-8 HHV-8 — in HIV-related lymphomas pathogenesis is well known, and most lymphomas are associated with these virus infections.
It is also known that chronic inflammation could contribute to the aggressive cancer lymphoma of any cancer, and even in the presence of a long period of viral suppression, papiloma urotelial da bexiga biomarkers remain at high levels in HIV-positive patients 28, Regarding hepatitis B and C, it is well known the role in the development of NHL in the general population due to B-cell proliferation and to chronic aggressive cancer lymphoma activation.
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Gene deregulation. HIV-associated lymphomas with BCL6 activation and without any other genetic lesions appear to have a better prognosis compared with those BCL-6 negative It often presents in advanced stages and with B symptoms, and extralymphatic involvement is often present, especially in patients with severe immunosuppression. Low CD4 counts have been associated with poor survival in multiple studies, while others have not found an association 37, Typically, patients present with poor performance status and high levels of lactate dehydrogenase 28, It is characterized by loss of mature B-cell markers, including CD20, and with an elevated proliferation index, being associated in almost all cases with EBV infection.
Primary effusion lymphoma PEL is a rare B-cell lymphoma characterized by effusions that can affect any serosa, pleura, pericardium and peritoneum.
Also, a rare solid extracavitary variant has been described.
Cancer hodgkins lymphoma symptoms
EBV is almost always present in aggressive cancer lymphoma cells and cerebrospinal fluid, compared with HIV-negative population in which is almost always negative 45, The clinical findings and standard radiological investigations are not sufficient for a positive diagnosis and it is usually mandatory to have a brain biopsy, but the combination of radiological findings and detectable EBV in cerebrospinal fluid in a severe immunocompromised HIV-positive patient may be sufficient for diagnosis, but only in selected cases Hodgkin lymphoma in HIV patients is usually associated with unfavorable characteristics like advanced stage and extranodal and bone marrow involvement.
The mixed cellularity is the most common HL subtype.
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Low CD4 count is cosidered an independent adverse prognostic factor 28, Multicentric Castleman disease is a very aggressive B-cell lymphoproliferative disorder and has an increased incidence in HIV-positive patients It can have various clinical features, affecting lymph nodes, with spleen enlargements, and is associated with B symptoms.
Hemophagocytic syndrome is a complication that can appear in the clinical course of the disease. Conclusions The improvement of survival in HIV-positive patients is the consequence of improved antiretroviral therapy, being more accessible and well tolerated, and to improved supportive strategies for these patients.
Aceste exemple pot conține termeni colocviali. Traducere "un limfom non-Hodgkin" în engleză Alte traduceri În timpul tratamentului său, a îndurat un transplant de măduvă pentru un limfom non-Hodgkin agresiv.
Also, the introduction of antiretroviral therapy is associated with a decrease in incidence of toxicities related to therapy of HIV-associated lymphomas. The treatment of patients with HIV-related lymphomas should be the same as in non-HIV lymphoma patients, and clinical trials that included HIV-positive patients with lymphoma showed that responses are identical in both populations, with the observation that a special attention should be granted to cART interaction with chemotherapeutic agents, to potential cumulative toxicities, and to risk for other infections in HIV-positive patients.
Bibliografie Conant MA.
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Management of human immunodeficiency virus-associated malignancies.