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HAART-related Lymphoma

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sierrarancher:
I am a survivor of lymphoma (1998) and have knowledge of one other HIV+ person who survived, one that is still battling it and one that died.  In Dec 2006 Aidsmeds.com published the following study regarding a connection between HAART and lymphoma:
http://www.aidsmeds.com/news/20061222clin007.html

I began HAART in 1997:  Crixivan (PI), Zerit (nuke) & Epivir(nuke).  I had resisted HAART because I was asymptomatic, except one case of shingles.  I don't recall my viral load (which test at that time was new) as being the reason for beginning HAART.  In January 1998 I began symptoms of lymphoma, which unfortunately was located internally (in the heart/lung region) and could not be detected manually.  After 2 spinal taps, which showed no lymphoma, an MRI of my chest showed the nodules.  They were biopsied and determined to be Stage IIB Hodgkins disease.  I began chemo in June 1998.

I developed pneumocystis and KS (on my lungs) during the chemo, which had to be terminated after half the cycles were completed.  I did the full course of radiation and completed it by Dec 1998.  I have not had a recurrence since--YAY!!

While there is a lot of discussion of lipids and lipodystophy as being "Metabolic Complications" of HAART, I haven't heard much on Lymphoma or other cancers, except for the study published in Blood.  I decided to put this poll out there to us LTS, as we have more experience over the years, especially since the advent of HAART.

I am wondering:

1.  If HAART must be modified depending on the amount of time a person has been infected (and/or re-infected).  In other words, should HAART be administered gradually for those with 'long-term' HIV infection?  Should any of the HAART meds be started gradually?

2.  Are any meds (in my case Crixivan, Epivir & Zerit) carcinogenic in some populations of HIV+ persons, especially LTS and non-progressors.  This would be good to know for LTS persons, as they switch drugs due to resistance.

3.  What role does Epstein Barr Virus play?  It was part of my pathology report determining that I had Hodgkins disease and not non-Hodgkins.

If you know of any more studies on this topic, I would be very interested in reading them.  I am also interested in any comments whatsoever.

aztecan:
Hi Sierra,

As it happens, I am on a very similar regimen to yours, except I take AZT rather than Zerit.


To answer your question: "Should any of the HAART meds be started gradually?" the answer is no.
Gradually starting any of the HAART meds raises the risk of resistance to that drug.

In other words, you cannot start off slowly. It is all or none, simply because of the nature of this bug we are living with.

Regarding any of the meds being carcinogenic, I have never heard of them being specifically carcinogenic. But then again, most of these combos are just a decade or so old, so who knows?

This was the trade off we made when we pushed to have HIV meds pushed quickly through for approval. On the one hand, many would be dead today, including myself most likely, if they hadn't come up with the cocktails in late 1995, early 1996.

On the other hand, we are in essence the guinea pigs as far as long-term side effects go.

I have known one person who developed non-Hodgkins lymphoma, the most common seen in hi-fivers. He underwent some brutal chemotherapy, but did not survive.

I think you raise a valid question, but I don't know if anyone has the answer.

HUGS,

Mark.

sierrarancher:
Hi Az,

Thanks for your response.  For my own case, I am extremely cautious of changing to a cocktail which could boost my CD4 count from around 200, where it has been hovering, to say 1000.  While most would say, 'oh my god, you've reconstituted your immune system'.  I have a history of lymphoma.  Therefore, I may (or may not) still have the Reed-Sternberg cells, Epsteiv-Barr virus combination (or whatever goes into the mix), which could go 'wild' again. 

If my understanding is right, (I'm an accountant,not a biochemist), when my immune system was reconstituted back in 1997, it MAY HAVE also sparked the growth of malignant lymphoma.  In my case, that spark turned into a full-fledged case of lymphoma, which almost killed me.  I must assume that I still have Reed Sternberg cells & EBV which are being held at bay by my little squadron of CD4s, since I have been in remission since 1998.

I guess my main point is I would llke to see more information on the mechanism of lymphoma as it relates to a suddenly reconstituted CD4 system.  The article published last December concerns me a great deal.

SASA39:
As a newbee just to sneak and whisper:
HAART is toxic and could cause cancer because that drug regimee disturb a healthy & natural living circle of cell ( Creb`s ) and therefore produce a free radicals who in a chain reaction produce a new free radicals......The damages on a RNK DNK are random and if you are lucky enough , or have a strong genes  , so to speak , you will not catch a .......
                         Sneaking out
                                                 Al

SASA39:
Got my leg stucked at the door : ( trying to sneak out)
Quote:The study showed that before the introduction of HAART, the incidence of non-Hodgkin's lymphoma in HIV-infected patients increased from 8.24 per 1,000 patient-years during the years 1983 to 1986 to 14.83 per 1,000 patient-years during 1991 to 1994. After the introduction of HAART, the trend reversed, with the incidence dropping to 3.7 per 1,000 patient-years in 1999 to 2002, Dr. Wolf said. “This was very significant, and shows the impact that highly active anti-retroviral drugs have made on this malignancy.”
http://www.medscape.com/viewarticle/483540
"This study confirms the favorable impact of HAART on the risk of occurrence of NHL," write the investigators, "but also confirms that a minimum duration of six months of HAART is required to prevent NHL. It also suggests HIV RNA level as a possible risk factor for AIDS-related NHL in the era of HAART, independent of immunodeficiency."
http://www.aidsmap.com/en/news/E1E7AD36-45DB-419C-BDF9-A9C84CB13C2B.asp
http://www.ti.ch/dss/DSP/ISTCP/RCT/pdf_ppt/Relazioni_e_Poster/2005/Lugano_HAART.pdf
Combined CHOP and HAART therapy improves AIDS-related lymphoma outcome
http://www.xagena.it/news/medicinenews_net_news/e634932bdcf89870094f7e681a87dd97.html
No Hodgkin Lymphoma in the era of HAART.
http://gateway.nlm.nih.gov/MeetingAbstracts/102253320.html
sneaking, sneaking.....................Al

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