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Table 1 Clinical, immunologic, and virologic characteristics among subjects diagnosed with NHL after starting newer-class antiretroviral regimens

From: Early development of non-hodgkin lymphoma following initiation of newer class antiretroviral therapy among HIV-infected patients - implications for immune reconstitution

  Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
Age (years) 46 57 47 46 43
Sex Male Male Male Male Female
Race/Ethnicity Black Black Black Hispanic, non-Black Black
Hepatitis B or hepatitis C coinfection No No No No No
Year of HIV diagnosis 1996 1983 1988 1991 2002
Antiretroviral regimen before starting newer-class HAART Tenofovir/emtricitabine, lopinavir/ritonavir Tenofovir, lamivudine, lopinavir/ritonavir Tenofovir/emtricitabine, zidovudine Emtricitabine, nevirapine, saquinavir, ritonavir Zidovudine/lamivudine, efavirenz
Newer-class HAART Regimens Raltegravir, darunavir, ritonavir, enfurvitide Raltegravir, tenofovir/emtricitabine, darunavir, ritonavir Raltegravir, etravirine, tenofovir/emtricitabine, zidovudine Raltegravir, tenofovir/emtricitabine, zidovudine, darunavir, ritonavir Raltegravir, tenofovir/emtricitabine, darunavir, ritonavir
Date of newer- class HAART initiation June 2007 November 2007 July 2007 October 2007 December 2007
Interval between newer- class HAART initiation and symptom onset (weeks) 3.5 3 20 6 5
Symptoms at onset of NHL Ataxia, urinary incontinence Left upper extremity numbness and weakness, diplopia Left neck mass Low back pain, weight loss Odonophagia, fever
Baseline CD4 6 128 44 69 27
Week 4 (± 1) CD4 Not performed Not performed 234 195 Not performed
Week 12 (± 2) CD4 15 4 250 40 33
Week 24 (± 2) CD4 Not performed 112 294 Not performed (deceased) Not performed
Baseline HIV viral load 1,135,366 8,111 > 500,000 156,303 17,767
Week 4 (± 1) viral load Not performed Not performed 132 84 Not performed
Week 12 (± 2) viral load 1,356 Undetectable Undetectable 195 Undetectable
Week 24 (± 2) viral load Not performed Undetectable Undetectable Not performed (deceased) Not performed
Imaging findings Brain MRI: 2.5 cm necrotic rim-enhancing lesion in the right basal ganglia with extensive vasogenic edema Brain MRI: two enhancing cavernous lesions abutting the right and left internal carotid arteries Neck CT scan: multiple enlarged left-sided level II to V lymph nodes with central necrosis and peripheral enhancement, lymphadenopathy in the left supraclavicular region Chest/abdominal/pelvic CT scan: massive lymphadenopathy in the neck, left supraclavicular and paratracheal regions, bilateral hilum, retroperitoneum, paraaortic, peripancreatic, and retrograstric regions, extending into the splenic hilum and left kidney, with bilateral renal vessels displaced anteriorly. Multiple masslike bilateral pulmonary nodules Neck CT scan: bilateral level II lymphadenopathy and a 6 mm nodule in the left apex with mild surrounding inflammation
Biopsy site and specimen Right medial temporal brain biopsy Left axilla lymph node excisional biopsy Left cervical lymph node excisional biopsy Left neck lymph node fine needle aspirate Right lateral oropharyngeal wall biopsy via larynoscopy
Pathology Diffuse large B-cell lymphoma Atypical Burkitt lymphoma with translocation (8,14) Diffuse large B-cell lymphoma Diffuse large B-cell lymphoma Plasmablastic large B-cell lymphoma
EBV in situ hybridization Positive Positive Tissue preparation inadequate Not performed Positive
Chemotherapy Yes Yes Yes Yes Yes
Outcome Died August 2008 Survived Survived Died March 2008 Survived