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

[ Vol. 15 , Issue. 4 ]

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 and Stefano Bonora   Pages 258 - 265 ( 8 )

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.

Affiliation:

Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10139 Torino, Unit of Infectious Diseases, Department of Medical Sciences, Unit of Haematology, Department of Oncology, University of Torino, Torino, Unit of Infectious Diseases, “Divisione A”, Ospedale Amedeo di Savoia, ASL TO2, Torino, Unit of Infectious Diseases, Department of Medical Sciences, Unit of Infectious Diseases, Department of Medical Sciences, Unit of Internal Medicine, Department of Medical Sciences, University of Torino, Torino, Unit of Infectious Diseases, Department of Medical Sciences, Unit of Infectious Diseases, Department of Medical Sciences, Unit of Infectious Diseases, “Divisione A”, Ospedale Amedeo di Savoia, ASL TO2, Torino, Unit of Infectious Diseases, Department of Medical Sciences, Laboratory of Microbiology and Molecular Biology, OspedaleAmedeo di Savoia, ASLTO2, Torino, Unit of Infectious Diseases, Department of Medical Sciences, Unit of Infectious Diseases, Department of Medical Sciences

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