The use of highly active antiretroviral therapy (HAART) and effective prevention and treatment strategies for opportunistic illnesses (OIs) have dramatically increased survival for people with HIV disease. As a result, there is a growing focus on serious complications that may arise during the course of illness, including AIDS-associated malignancies (cancers). Current AIDS-defining malignancies include Kaposi’s sarcoma (KS), primary central nervous system (CNS) lymphoma, systemic non-Hodgkin’s lymphoma (NHL), and invasive cervical cancer. This article will review systemic NHL.
Most people today appreciate the value of antiretroviral therapy, if not its price. This is because the price of expensive anti-HIV medications in the U.S. is largely, and thankfully, invisible. Although uninsured or underinsured people with HIV may have to pay for their drugs out of pocket, the cost of pharmaceuticals for most HIV positive Americans is borne by private insurance or by the government through Medicaid or a state AIDS Drug Assistance Program (ADAP). Copayments collected by the pharmacy—which can be a significant burden—are as close as many people get to the byzantine world of prescription drug pricing.
A wide variety of monitoring tests are available to help gauge HIV disease progression and the state of overall health. HIV viral load tests provide a picture of viral activity,while CD4 cell counts shed light on the status of the immune system and can help physicians predict—and therefore prevent—the development of opportunistic illnesses (OIs).
Salvage therapy is an approach taken when previous anti-HIV treatments fail to achieve desired goals, which include undetectable viral load, CD4 cell levels above 200 cells/mm3, and the prevention of HIV disease progression. It is one of the most difficult situations to face as a patient, and one of the most problematic challenges for health-care providers. Though sometimes euphemistically referred to as “management of treatment-experienced patients,” many HIV positive people, having already exhausted the benefits of at least a couple of drug combinations, think of their next regimen as salvage or “rescue” therapy.
Coinfection with HIV and the hepatitis C virus (HCV) or hepatitis B virus is a growing public health concern. Because the diseases are spread in similar ways—notably through shared use of needles to inject drugs and sexual activity—many people are coinfected with HIV and HCV, HIV and HBV, or even all three viruses.
Non-Hodgkin’s Lymphoma
This information is designed to support, not replace, the relationship that exists between you and your doctor.