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