Diagnosis, prophylaxis and treatment of central nervous system involvement by non-hodgkin lymphoma in HIV-infected patients

Abstract

With the widespread use of highly active antiretroviral therapy (HAART), the incidence of systemic non-Hodgkin lymphoma (NHL) in patients infected with the human immunodeficiency virus (HIV) has declined. HAART has also modified the clinical manifestations of these tumours, with a lower frequency of involvement of the central nervous system (CNS). Before the introduction of HAART, up to 25 % of patients showed CNS involvement; currently, the frequency of meningeal involvement at the time of diagnosis of NHL in HIV-infected patients varies between 3 and 5 %, and its frequency is related to histological subtype, ranging from uncommon in indolent lymphomas to more frequent in aggressive lymphomas such as diffuse large B-cell lymphoma (DLBCL), lymphoblastic lymphoma, blastoid variant of mantle cell lymphoma and Burkitt’s lymphoma (BL). Clinical criteria, such as involvement of the paranasal sinus, testes, orbital cavities or bone marrow, advanced stage, high International Prognostic Index, elevated LDH levels and the involvement of multiple extranodal sites all help to better identify the risk factors in patients for whom the administration of prophylaxis is strongly recommended.