ABSTRACT
ABSTRACT
Background:
The 5th edition of the
World Health Organization Classification of Hematolymphoid
Tumors recently defined immune
deficiency/dysregulation (IDD)-associated-lymphoid-proliferations in
HIV settings, where information is scarce, often gone under or misdiagnosed.
Objectives:
To describe the clinical picture, histopathology, and outcomes of IDD-associated-lymphoid-proliferations
Epstein-Barr virus+ (
EBV) in people living with
HIV without
organ transplantation, antiretroviral
therapy (
ART) treated.
Methods:
HIV+
patients diagnosed with IDD-associated-lymphoid-proliferations seen at an
academic medical center in
Mexico from 2016 to 2019 were included. Immunohistochemical studies,
in situ hybridization, and
polymerase chain reaction analysis for
EBV and LMP1
gene deletions were performed and correlated with clinical data.
Results:
We included 27
patients, all men who have sex with men, median age 36 years (interquartile range [IQR] 22-54). The median baseline CD4+
T cells were 113/mL (IQR 89-243), the CD4+/CD8+ ratio was 0.15 (IQR 0.09-0.22), and the
HIV viral load was 184,280 copies/mL (IQR 76,000-515,707). Twenty
patients (74.07%) had IDD-associated-lymphoid-proliferations
hyperplasia plasma cell type
EBV+, 3 (11.1%) had
hyperplasia mononucleosis-like type (IM-type), 1
patient (3.70%) had florid follicular
hyperplasia, 3 (11.1%) IDD-associated-lymphoid-proliferations polymorphic type, and there were 22 cases (81.4%) of synchronic
Kaposi Sarcoma. Two
patients were diagnosed with
Hodgkin lymphoma following a second
positron emission tomography-computed tomography scan-guided
biopsy. The median follow-up was 228 weeks (IQR 50-269); 6
patients died (22.2%) of causes unrelated to IDD-associated-lymphoid-proliferations related.
Conclusion:
IDD-associated-lymphoid-proliferations
EBV+ occured in severely immunosuppressed
HIV+
patients, a high percentage of whom had concomitant
Kaposi sarcoma. The
prognosis was good in
patients treated only with
ART.
