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LYMPHOMA IN HIV-2–INFECTED PATIENTS IN CART ERA: A 15-PATIENT SINGLE-CENTER SERIES
Anne-Marie Ronchetti1, Sophie Matheron2, Lionel Galicier1, Florence Damond2, Nadia Mahjoub1, Amel Besseghir3, Veronique Meignin1, Francois Simon1, Eric Oksenhendler1, Laurence Gerard1
1Saint Louis Hosp, Paris, France,2Bichat-Claude Bernard Hosp, Paris,3INSERM, Bordeaux, France
In France HIV-2 infection represents 1.6% of all HIV infections. Despite difference in pathogeniciy and disease progression between HIV-2 and HIV-1 infection, similar patterns of opportunistic complications are reported at similar CD4 level. However, although lymphoma occurs in 4 to 5% of HIV-1 patients (pts) and is a major cause of mortality, this complication has been rarely reported in HIV-2-infected pts.
Patients were recruited from an ongoing prospective single-center cohort of HIV-lymphoma. Characteristic of HIV-2 pts were compared with HIV-1 pts included in the cohort >1996. Prevalence and incidence of HIV-2-lymphoma were evaluated from a national prospective multicentric French cohort of HIV-2 patients, including 1068 pts (ANRS-CO5).
Among the 949 pts included in the HIV-lymphoma cohort, 15 were HIV-2-infected (1.6%), close to the 2% prevalence of HIV-2 infection in our institution (60/3000). In the ANRS CO5 cohort, the prevalence of lymphoma was 1.7% and the incidence 0.9/1000 PY. Compared to HIV-1 pts, HIV-2 pts were older and more pts were originated from West Africa (Table). At the time of lymphoma diagnosis, median CD4 cell count was similar in both groups, but more HIV-2 pts had an undetectable viral load. Clinical presentation of lymphoma was aggressive in both groups. Histologic subtype was HL in 18% of HIV-2 and 13% of HIV-1 pts. Among NHL, diffuse large B-cell lymphoma and Burkitt lymphoma were the most frequent histologic subtype in both groups. All but one HIV-2 pt received intent-to-treat chemotherapy, adapted to histologic subtype. Concomitant cART was maintained or introduced in all pts. Complete remission was achieved in 60% of HIV-2 and 73% of HIV-1 pts. The median overall survival (OS) was lower in HIV-2 pts (16 mths) compared to HIV-1 pts (12 yrs). The cause of death in HIV-2 pts was lymphoma (6) and treatment toxicity (4), no pt died from AIDS.
This is the first series of lymphoma in HIV-2 pts. The incidence was close to the incidence of HIV-1-lymphoma in France (0.8/1000 for NHL and 1.2/1000 PY for HL). HIV-2 pts developed lymphoma at the same CD4 level than HIV-1 pts, but a higher proportion of pts had controled HIV infection. Despite some differences in histological subtypes, clinical presentation of lymphoma was close to HIV-1. However, although all pts received adapted chemotherapy and concomitant cART, HIV-2-lymphoma displays an unexpected poor survival, with median OS of 16 mths.