AIDS-related lymphoma
Template:Infobox medical condition (new) AIDS-related lymphoma describes lymphomas occurring in patients with acquired immunodeficiency syndrome (AIDS).<ref name="pmid11588028">Template:Cite journal</ref><ref name="pmid11642021">Template:Cite journal</ref>
A lymphoma is a type of cancer arising from lymphoid cells. In AIDS, the incidence of non-Hodgkin's lymphoma, primary cerebral lymphoma and Hodgkin's disease are all increased. There are three different varieties of AIDS-related lymphoma: Diffuse large B-cell lymphoma, B-cell immunoblastic lymphoma, and Burkitt's lymphoma (small non-cleaved cell lymphoma).<ref name="cancer1">Template:Cite web</ref>
Signs and symptoms
The histologic classification of the lymphoma, as well as the locations and severity of the disease, all influence the clinical presentation of HIV-related lymphomas.<ref name="UpToDate w299">Template:Cite web</ref> HIV-related lymphomas are more likely to present with advanced stage disease, constitutional symptoms (also known as "B" symptoms; fever, weight loss, and night sweats), extranodal involvement, or disease involving unusual locations (such as the body cavity or soft tissue) than lymphomas in the HIV-negative population.<ref name="GI-lymphomas">Template:Cite journal</ref><ref name="Burkitts Lymphoma">Template:Cite journal</ref>
HIV-related lymphomas can present with a variety of clinical symptoms, including organomegaly, lymphadenopathy, and/or constitutional symptoms. Unknown fever, cytopenias, tumor lysis syndrome (including lactic acidosis, hyperkalemia, hyperuricemia, hypocalcemia, hyperphosphatemia, and elevated lactate dehydrogenase), and other isolated laboratory abnormalities (such as hypercalcemia) are observed in certain patients.<ref name="Evolution of the incidence">Template:Cite journal</ref>
Causes
HIV-positive individuals' lymphomas vary widely and can be classified into several histologic subtypes.<ref name="era of combination antiretroviral therapy">Template:Cite journal</ref> The two primary lymphoma types that develop in HIV-positive individuals are non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL).<ref name="HIV-Associated Malignant Lymphoma">Template:Cite journal</ref>
Diffuse large B-cell lymphoma is a highly aggressive type of B-cell lymphoma. It is distinguished by the widespread proliferation of large neoplastic B lymphocytes with nuclei that are equal to or larger than normal histiocytic nuclei.<ref name="Classification of Diffuse Large B-cell Lymphomas">Template:Cite journal</ref> The illness manifests with B symptoms at an advanced stage of the illness. It mostly affects patients who are severely immunosuppressed and can occur at nodal or extranodal sites, with the gastrointestinal tract being the most common site.<ref name="EPIDEMIOLOGY TO CLINICAL MANAGEMENT">Template:Cite journal</ref><ref name="Magangane Mohamed Naidoo 2020 p. ">Template:Cite journal</ref> It makes up between 45 and 50 percent of all lymphomas seen in this group, making it the most prevalent AIDS-associated lymphoma subtype.<ref name="Wu Chen Zhang Li 2019 p. ">Template:Cite journal</ref><ref name="Meister Hentrich Wyen Hübel 2018 pp. 119–126">Template:Cite journal</ref> All ages are affected by DLBCL, which typically manifests as a rapidly growing lymph node mass in the neck or abdomen.<ref name="HIV/AIDS Associated Lymphoma">Template:Cite journal</ref> Up to 40% of patients have extranodal extramedullary disease, and about 30% of patients exhibit B symptoms.<ref name="Shah Keraliya Jagannathan Tirumani 2017 p. 54">Template:Cite journal</ref>
The second most prevalent NHL subtype that affects HIV-positive individuals with a comparatively high CD4 cell count is Burkitt's lymphoma. Patients typically have elevated lactate dehydrogenase levels and poor performance status.<ref name="HIV/AIDS Associated Lymphoma" /> The central nervous system is involved in 8 to 28% of cases, with extranodal involvement occurring more frequently.<ref name="EPIDEMIOLOGY TO CLINICAL MANAGEMENT" /> It usually manifests at a younger age and with CD4 cell counts greater than 200 cells/μL.<ref name="JCDR Research and Publications 2013 p. ">Template:Cite journal</ref> It develops quickly and is a kind of tumor that starts from B cells. In addition, it is fatal if untreated.<ref name="Ansorge 2021 l147">Template:Cite web</ref> Burkitt's lymphoma is linked to a high incidence of oral cavity involvement and makes up 10-15% of AIDS-defining lymphomas.<ref name="HIV/AIDS Associated Lymphoma" /> Three clinical subtypes of Burkitt's lymphoma have been identified: endemic, sporadic, and immunodeficiency-related.<ref name="Dozzo Carobolante Donisi Scattolin 2016 pp. 11–29">Template:Cite journal</ref> Thirty to forty percent of AIDS-related NHL cases are Burkitt's lymphoma subtype, which is most prevalent in HIV/AIDS patients.<ref name="Ansorge 2021 l147"/>
Primary central nervous system lymphoma (PCNSL) is a subtype of NHL that impacts the eyes, brain, spine, and cerebrospinal fluid in the central nervous system.<ref name="Grommes DeAngelis 2017 pp. 2410–2418">Template:Cite journal</ref> It appears in patients who have severe immune suppression; since the advent of highly active antiretroviral therapy, its incidence has declined in these patients. The majority of PCNSL linked to HIV is Epstein-Barr virus positive.<ref name="HIV/AIDS Associated Lymphoma" /> Furthermore, unlike HIV-negative PCNSL, patients typically present with multiple brain lesions and/or changes in mental status or focal neurologic symptoms.<ref name="Meister Hentrich Wyen Hübel 2018 pp. 119–126" /><ref name="Dunleavy Wilson 2012 pp. 3245–3255">Template:Cite journal</ref> Changes in mental state, intracranial pressure symptoms (headache, nausea, vomiting, papilledema), and local compression symptoms (epilepsy, memory loss, unstable gait, visual impairment, slurred speech) are the most common symptoms of PCNSL.<ref name="Zhao Ma Zhang Zheng 2019 p. ">Template:Cite journal</ref>
Primary effusion lymphoma is a distinct subtype of aggressive B-cell NHL. It is brought on by HHV8, commonly referred to as KSHV, or Kaposi sarcoma-associated herpesvirus.<ref name="Jarrett 2005 pp. 176–186">Template:Cite journal</ref><ref name="Antar El Hajj Jabbour Khalifeh 2014 pp. e190–e190">Template:Cite journal</ref> It is uncommon, making up 0.3% of NHL in the general population and 4% of NHL linked to HIV. Between 60 and 90 percent of cases of primary effusion lymphoma have EBV co-infection, although its pathogenesis is unknown.<ref name="HIV/AIDS Associated Lymphoma" /> There are malignant lymphomatous effusions in the pericardium, peritoneal cavity, and pleural space.<ref name="Narkhede Arora Ujjani 2018 pp. 3747–3754">Template:Cite journal</ref>
Plasmablastic lymphoma (PBL) originates from terminally differentiated, activated B-cells at the post-germinal center that are changing from immunoblasts to plasma cells.<ref name="HIV/AIDS Associated Lymphoma" /> About 2% of all AIDS-associated lymphomas are PBL-associated lymphomas.<ref name="Castillo Bibas Miranda 2015 pp. 2323–2330">Template:Cite journal</ref> HIV infection is closely associated with this uncommon form of lymphoma, which primarily affects the oral cavity.<ref name="Castillo 2011">Template:Cite journal</ref>Template:Please verify
With a widespread proliferation of massive neoplastic cells that resemble B-cell immunoblasts but have the immunophenotype of plasma cells, it is incredibly aggressive.<ref name="Broccoli Nanni Stefoni Agostinelli 2018 p. ">Template:Cite journal</ref>
Hodgkin lymphoma (HL) is one of the most common cancers that do not indicate AIDS, and since highly active antiretroviral therapy was introduced, its incidence has increased. It is a germinal center-derived cell that produces Hodgkin Reed–Sternberg (HRS) cells.<ref name="HIV/AIDS Associated Lymphoma" /> It is more common in immunocompromised individuals, especially those with HIV.<ref name="Ul-Haq Dalla Pria Suardi Pinato 2018 p. ">Template:Cite journal</ref> Compared to mild immune compromise, the incidence of HL is lower in states of extreme immunodeficiency. It's possible that there was insufficient immunological contact between non-neoplastic inflammatory cells and HRS cells.<ref name="Grogg Miller Dogan 2006 pp. 1365–1372">Template:Cite journal</ref>
Mechanism
HIV-positive patients have a higher incidence of malignancies for a variety of reasons. These consist of inflammation, cytokine dysregulation, and persistent antigenic stimulation.<ref name="HIV/AIDS Associated Lymphoma" /> Moreover, oncogenic viruses are more likely to infect HIV/AIDS patients.<ref name="Yarchoan Uldrick 2018 pp. 1029–1041">Template:Cite journal</ref> Thus, a variety of factors, such as a compromised immune system, genetic changes, viral infection, and persistent B cell activation, contribute to the pathogenesis of HIV/AIDS-associated lymphoma.<ref name="HIV/AIDS Associated Lymphoma" />