Therapeutic challenges of AIDS-related non-Hodgkin's lymphoma in the United States and East Africa.
Therapeutic challenges of AIDS-related non-Hodgkin's lymphoma in the United States and East Africa.
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DOI：
10.1093/jnci/94.10.718
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发表时间：
2002-05
期刊：
影响因子：
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通讯作者：
M. W. Otieno;C. Banura;E. Katongole‐Mbidde;John L. Johnson;M. Ghannoum;A. Dowlati;R. Renne;E. Arts;C. Whalen;M. Lederman;S. Remick
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文献类型：
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作者：
M. W. Otieno;C. Banura;E. Katongole‐Mbidde;John L. Johnson;M. Ghannoum;A. Dowlati;R. Renne;E. Arts;C. Whalen;M. Lederman;S. Remick
非霍奇金淋巴瘤（NHL）仍然是人类免疫缺陷病毒（HIV）感染患者第二常见的恶性并发症。随着我们进入艾滋病流行的第三个十年，抗逆转录病毒疗法的发展和联合抗病毒策略的出现显然极大地影响了艾滋病毒感染的自然史及其肿瘤并发症。例如，美国艾滋病相关淋巴瘤的发病率可能首次出现下降趋势。然而，在世界上艾滋病毒感染负担最严重的地区，例如东非，艾滋病相关淋巴瘤是发病率和死亡率日益增加的原因。淋巴瘤的治疗随着抗逆转录病毒治疗的进步而不断发展。输注化疗方案可能比其他方案和时间表具有优势，但尚未进行比较试验。东非需要采取务实的方法，可利用临床试验数据制定治疗策略来治疗这种疾病。在规划治疗策略时，必须考虑到该地区艾滋病毒感染表现的差异以及细胞毒性化疗的固有困难。对艾滋病毒感染和淋巴瘤发病机制的进一步了解也可能会改善治疗干预措施。
Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. As we enter the third decade of the acquired immunodeficiency syndrome (AIDS) epidemic, it is apparent that the evolution of antiretroviral therapy and the emergence of combination antiviral strategies have greatly affected the natural history of HIV infection and its neoplastic complications. For example, there may be a trend for declining incidence of AIDS-related lymphoma in the United States for the first time. However, in regions of the world where the burden of HIV infection is greatest, such as in East Africa, AIDS-related lymphoma is an increasing cause of morbidity and mortality. Treatment of lymphoma has evolved coincident with improvements in antiretroviral therapy. Infusional chemotherapy regimens may offer advantages over other regimens and schedules, but comparative trials have not been done. Clinical trial data are available on which to develop therapeutic strategies to treat this disease in East Africa where pragmatic approaches are needed. Both the differences in manifestations of HIV infection and the inherent difficulties in administering cytotoxic chemotherapy in this part of the world must be taken into consideration in planning therapeutic strategies. Improved understanding of the pathogenesis of HIV infection and lymphoma will likely yield improved therapeutic interventions as well.