HIV Associated Lymphoma: A Five Year Clinicopathological study

Rajalakshmi, R (2014) HIV Associated Lymphoma: A Five Year Clinicopathological study. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Malignancies are more common in immunocompromised individuals as compared to the general population. In the developed countries 34% of AIDS patients suffer from aggressive malignancies which are resistant to treatment and are often fatal. On the other hand, in India, the incidence of malignancies in patients with HIV is only 3-4% which is attributed to the under diagnosis and early deaths from opportunistic infections. AIMS AND OBJECTIVES: 1. To ascertain the frequency and subtypes of HIV associated lymphomas diagnosed in the pathology department of Christian Medical College and Hospital during a five year period, January 2007 till December 2011. 2. To sub classify the types of HIV associated lymphomas using the WHO 2008 classification and to compare this with the lymphomas occurring in the general population during the same period and with the world literature. 3. To find out the association of Epstein Barr virus and Human Herpes Virus 8/Kaposi Sarcoma associated Herpes Virus with these lymphomas by insitu hybridization and immunohistochemical techniques respectively. 4. To evaluate the clinical profile of these patients including staging, CD4 count, IPI score, prognosis and follow-up. MATERIALS AND METHODS: The study was performed in the Norman Institute of Pathology, Christian Medical College and Hospital, Vellore, India. The study period was 5 years from January 2007 to December 2011.This is a partly retrospective and partly prospective study. All lymphoma cases diagnosed in our department over this five years period were identified and among these only the patients who were positive for HIV by serology (ELISA) were included in this study. The tissue blocks were obtained from the archives of our department and the patients’ clinical details were obtained from the clinical workstation and from patients’ charts obtained through medical records department or from the biopsy request forms for outside referral biopsies. INCLUSION CRITERIA: All patients diagnosed to have lymphoma and who were positive for HIV serology (ELISA) over the period January 2007 to December 2011 were included in this study. EXCLUSION CRITERIA: Patients who were seronegative for HIV, those for whom HIV serology was not done and the outside referral cases for which HIV status were not known, were excluded. STATISTICAL METHODS: 1. Data entry was done using epi data software. 2. Data analysis was done using SPSS soft ware. 3. To compare the subtypes of lymphoma with HIV negative population two proportion test was used. 4. Pearson correlation was used to find the correlation of CD4 with the patients status. 5. Log rank statistics was used for assessing the outcome predictors such as IPI score and staging. 6. Kaplan Meir survival curve was plotted for survival analysis. RESULTS: A total of 3346 lymphomas were diagnosed during a 5 year period 01/01/2007 to 31/12/2011 in Normal Institute of Pathology, Christian Medical College and Hospital, Vellore. Of these 73 patients (2%) were found to be positive for HIV infection by serology (ELISA). The rest of them were seronegative or biopsies from outside hospitals with HIV status unknown. CONCLUSION 1. This is the largest detailed clinicopathological study of HIV associated lymphomas from India. 2. DLBCL was the commonest type of HIV associated lymphoma followed by plasmablastic lymphoma, Burkitt lymphoma, Hodgkin lymphoma, PTCL NOS, ALCL, extranodal NK/T-cell lymphoma and extracavitary PEL. 3. Most cases were nodal, though there were a large number (44%) of extranodal primary sites involved. 4. Most cases (69%) presented with high stage disease. 5. Survival was uniformly poor in 36% of the cases on whom the follow up was available with a median survival of 28 months. 6. EBV association was seen in 47% of cases. Plasmablastic lymphomas and Hodgkin lymphoma were most often associated with EBV (90% and 100% respectively). 7. There were significant differences between lymphomas in HIV positive individuals and lymphomas in HIV negative patients, the former being more aggressive types with high stage at presentation, more frequent extranodal involvement, EBV association and poor survival. 8. The striking differences from world literature included the higher frequency of plasmablastic lymphomas, lack of primary CNS lymphomas and low association with HHV8 (LANA immunohistochemistry) in our patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: HIV Associated Lymphoma, Five Year Clinicopathological study.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 23 Mar 2020 16:43
Last Modified: 17 Aug 2020 05:35

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