High Incidence of Infections in HIV-positive Patients Treated for Lymphoproliferative Disorders

Author(s): Andrea Calcagno*, Anna Lucchini, Daniele Caracciolo, Rosanna Balbiano, Margherita Bracchi, Francesca Sordella, Giovanna Gregori, Filippo Lipani, Sabrina Audagnotto, Monica Chiriotto, Giovanni Cavaglià, Valeria Ghisetti, Giovanni Di Perri, Stefano Bonora.

Journal Name: Current HIV Research

Volume 15 , Issue 4 , 2017

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Abstract:

Background: Lymphoproliferative disorders are frequently diagnosed in HIV-positive patients and severe infections may occur during antineoplastic treatments: the incidence and impact of such events are not well-characterized.

Objective: To describe the occurrence and mortality of incident infections in HIV-positive individuals treated for lymphoproliferative disorders.

Methods: A retrospective study in HIV-positive adults with lymphoproliferative disorders (2000- 2012) who were hospitalised to receive antineoplastic chemotherapy; antimicrobial prophylaxis with alternate day co-trimoxazole (800/160 mg) was administered to all individuals.

Results: 103 patients were included: mostly males (81, 78.6%), Caucasians (101, 98.1%), with a median age of 43 years (39-51). Fifty-eight (56.3%) patients had non-Hodgkin’s lymphoma (NHL), thirty-two (29.1%) had Hodgkin’s lymphoma (HL) and ten patients (9.7%) had Burkitt’s lymphoma (BL). Five year survival was 63.1%: the best survival rates were reported in HL (78.1%), followed by NHL (58.6%) and BL (50%). Forty-four patients (42.7%) developed 82 infections during follow up: identified causative agents were bacteria (35, 42.7%), viruses (28, 34.1%), mycobacteria (7, 8.5%), protozoa (7, 8.5%) and fungi (5, 6.1%). Cytomegalovirus infections (n=17, including 5 endorgan diseases) emerged 53 days after the diagnosis: multivariate analysis showed CD4+ cell count <100/uL as the only independently associated factor (p<0.001, aOR=23.5). Two factors were associated with mortality risk: an IPI/IPS-score of >2 (p=0.004, aOR=6.55) and the presence of CMV disease (p=0.032, aOR=2.73).

Conclusion: HIV positive patients receiving treatment for lymphoproliferative disorders suffer from a high incidence of infections and associated mortality risk. Tailored prophylactic strategies need to be considered in this setting.

Keywords: HIV, lymphoma, survival, infection, cytomegalovirus, mycobacteria, HAART.

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Article Details

VOLUME: 15
ISSUE: 4
Year: 2017
Page: [258 - 265]
Pages: 8
DOI: 10.2174/1570162X15666170531085838
Price: $58

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