revisión sobre linfomas asociadas al HIV

1. M R 1 O S C A R M A L P A R T I D A T A B U C H I
I N F E C T O L O G Í A - H N G A I
Linfomas asociados al HIV

2. General issues
 25 to 40% of (HIV)-positive patients will develop a
malignancy, 10% NHL
 70 to 90 % AIDS-related lymphomas are highly
aggressive and are almost exclusively the
immunoblastic variant of DLBCL and Burkitt
lymphoma (BL). RR for highly aggressive
lymphomas is more than 400-fold overall , and
650-fold and 260-fold for DLBCL and BL,
respectively among HIV+

4. AIDS-defining malignancies
 KS
 (NHL) of high-grade pathologic type and of B cell or
unknown immunologic phenotype [8]
 Invasive cervical carcinoma

5. AIDS-NHL (by location)
 Systemic NHL
 Primary central nervous system (CNS) lymphoma
15%
 Primary effusion (or body cavity) lymphoma <1%

6. NHL subtypes HIV
 Burkitt lymphoma (approximately 25 percent)
 DLBCL, approximately 75 percent
 Plasmablastic lymphoma (less than 5 percent)
 T cell lymphoma (1 to 3 percent)
 Indolent B cell lymphoma (less than 10 percent

7. Non-AIDS defining malignancies
 HL most common: MSM, mixed cellularity 60%
 Use of ART has not reduced incidence

8. Risk factors
 Directly related with inmune system dysfunction
 CD4 count: BL vs PCNSL
 HIV viral load
 HAART: BL

10. Clinical manifestations
 Frequent B symptoms
 Extranodal disease
 Unusual locations (body cavity, soft tissue, rectum)
 Advanced stage
 Symptoms of advanced disease: mass effect in
virtually any organ

11. Evaluation
 Biopsy: 25-35% bone marrow involvement, multiple
node biopsies may be required (HIV-related
hyperplasia), FDG-PET for location.
 GI tract: endoscopy
 CNS: 5-20% , <100 CD4, MRI, flow citometry

12. Differential diagnosis
 Disseminated mycobacterial, fungal, bacterial
infections
 Castleman’s disease
 KS

13.  Gracias!