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JNCI Journal of the National Cancer Institute 2006 98(15):1088-1091; doi:10.1093/jnci/djj302
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© The Author 2006. Published by Oxford University Press.

BRIEF COMMUNICATION

Highly Active Antiretroviral Therapy and Human Immunodeficiency Virus–Associated Primary Cerebral Lymphoma

Mark Bower, Tom Powles, Mark Nelson, Sundhiya Mandalia, Brian Gazzard, Justin Stebbing

Affiliations of authors: Departments of Oncology and HIV Medicine, The Chelsea and Westminster Hospital, London, United Kingdom

Correspondence to: Justin Stebbing, MA, MRCP, PhD, Department of Oncology, The Chelsea and Westminster Hospital, 369 Fulham Rd., London SW10 9NH, UK (e-mail: justinstebbing{at}gmail.com).

From a cohort of 9621 human immunodeficiency virus type 1-infected individuals, we identified 61 patients with primary central nervous system lymphoma (PCL) who had a median survival of 1.3 months. We compared clinicopathologic variables of patients who were treated in the pre-highly active antiretroviral therapy (HAART) and HAART eras and investigated whether exposure to antiretroviral agents with differing cerebrospinal fluid penetrations was associated with risk for PCL. All statistical tests were two-sided. Incidence of PCL was lower in the HAART era (1.2 cases per 1000 patient-years, 95% confidence interval [CI] = 0.8 to 1.9) than in the pre-HAART era (three cases per 1000 years, 95% CI = 2.1 to 4.0; P<.001), and overall survival was longer (median survival = 32 days, range = 5–315 days, versus 48 days, range = 15–1136 days; log rank P = .03). In the HAART era, fewer patients had prior acquired immunodeficiency syndrome-defining illnesses than in the pre-HAART era (64% versus 90%; P = .013), and patients were more likely to have the diagnosis of PCL confirmed histologically or by polymerase chain reaction (77% versus 26%; P<.001). Exposure to specific antiretroviral agents was not associated with risk for PCL.


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