In addition to antitumor therapy, essential components of an optimal non-Hodgkin's lymphoma treatment strategy include antiretroviral therapy, prophylaxis for opportunistic infections, and rapid recognition and treatment of intercurrent infections. Patients with HIV positivity and underlying immunodeficiency have poor bone marrow reserve, thereby compromising the potential for drug dose intensity. There is a risk of intercurrent opportunistic infection, which may also lead to a decrease in drug delivery. Furthermore, chemotherapy itself compromises the immune system thus increasing the likelihood of opportunistic infection. In general, response rates are lower than for a non-HIV population.
Complete responses occur but tend to be of shorter duration with frequent relapses.
Most studies have used a lower dose intensity, and delays in treatment have been common. Several investigators have attempted to use intensive chemotherapy regimens, with a median overall survival time for treated patients of approximately 6 to 9 months. The optimal dose intensity of chemotherapy in these patients is under clinical evaluation. Outside the context of a clinical trial, low-dose chemotherapy should be considered for most patients with HIV infection and a CD4 lymphocyte count under 200. Gisselbrecht C, Oksenhendler E, Tirelli U, et al.