June 12, 2013

B-Cell Lymphomas in HIV/HCV-Coinfected Patients

Published in Journal Watch HIV/AIDS Clinical Care June 10, 2013

The histology of lymphomas in this population differs from that seen in HIV-monoinfected patients, suggesting a novel mechanism of lymphomagenesis.

HIV-monoinfected patients have an increased risk for B-cell non-Hodgkin lymphoma (NHL) — most commonly, high-grade malignancies such as diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma. Several studies have suggested that hepatitis C virus (HCV)-monoinfected patients may also have an increased risk for NHL. To understand whether HCV coinfection influences the types of lymphomas seen in HIV-infected patients, investigators in France examined a series of tumors found in HIV/HCV-coinfected and HIV-monoinfected patients.

Forty-one HIV-monoinfected patients and 6 HIV/HCV-coinfected patients with NHL were enrolled in a prospective study between 2007 and 2009. At the time of NHL diagnosis, HIV RNA was undetectable in 4 of the 6 coinfected patients and 16 of the 41 HIV-monoinfected patients; the median CD4 count was 449 and 292 cells/mm3, respectively. In the HIV/HCV-coinfected group, 5 of the 6 cases had features of lymphoplasmacytic lymphoma (LPL) or marginal zone lymphoma (MZL; e.g., mucosal-associated lymphoid tissue lymphoma). In the HIV-monoinfected group, the most common subtype was DLBCL; only 1 case had features of MZL/LPL.

The course of one coinfected patient was notable. After the diagnosis of splenic MZL, he received antiretroviral therapy, with suppression of his HIV RNA but no hematologic response. Subsequent anti-HCV therapy (pegylated interferon and ribavirin) resulted in a dramatic decrease in clonal B cells in his blood coinciding with a drop in HCV RNA level.

Comment: Lymphoma has been associated with several infectious agents, including human herpes virus-8, human T-lymphotropic virus type 1, Epstein-Barr virus, HIV, and Helicobacter pylori. Now, this study suggests that hepatitis C virus coinfection might be linked to particular types of non-Hodgkin lymphoma in HIV-infected patients. The hematologic response to anti-HCV therapy seen in the current study is reminiscent of a previous report describing regression of splenic lymphoma in HCV-monoinfected patients after interferon therapy (N Engl J Med 2002; 347:89) and suggests that, as with Helicobacter-associated lymphoma, chronic antigenic stimulation may contribute to lymphomagenesis.

Rajesh T. Gandhi, MD

Citation(s):

Terrier B et al. Characteristics of B-cell lymphomas in HIV/HCV-coinfected patients during the combined antiretroviral therapy era: An ANRS CO16 LYMPHOVIR cohort study. J Acquir Immune Defic Syndr 2013 Jun 1; 63:249. (http://dx.doi.org/10.1097/QAI.0b013e31828a77f0)

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