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Non-Hodgkin lymphoma (NHL) is a group of cancers that originate in the lymphatic system, a collection of lymph nodes, vessels, and organs that produces the immune system's infection-fighting cells and carries them throughout the body. NHL is 20 to 50 times more common among people infected with HIV than among those without the virus. Most cases of NHL are not AIDS related. The outcome for HIV-infected people who develop lymphoma is improving as doctors gain insight into its causes, and as treatment for both HIV and lymphoma advances. Controlling the HIV virus after treatment for lymphoma will reduce the risk that the cancer will recur.
In addition to common symptoms of non-Hodgkin lymphoma, such as swollen lymph nodes, many patients with AIDS-associated lymphomas have so-called B symptoms, such as fever, night sweats, and weight loss.
The majority of NHLs in HIV-positive patients are aggressive, large-cell lymphomas. Burkitt lymphoma, a very fast-growing type of lymphoma, is also common among HIV-positive patients. People with HIV may also develop unusual HIV-associated lymphomas, including primary effusion lymphoma, which usually arises in the lung cavity; plasmablastic lymphoma, which often develops in the jaws and mouth; and primary central nervous system lymphoma (PCNSL), which develops in the brain. PCNSL is very rare in people who have CD4 counts above 50. (CD4 cells are the primary target of the HIV virus, commonly thought of as Helper T cells. Very low CD4 counts are one definition of AIDS, as they signal severe immunocompromise.)
Treatment for AIDS-associated lymphomas almost always includes chemotherapy or, less often, radiation therapy. New research indicates that patients with immune systems supported by highly active antiretroviral therapy (HAART) tolerate and respond well to standard chemotherapy for non-Hodgkin lymphoma.
