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Characteristics of B-Cell Lymphomas in HIV/HCV-Coinfected Patients

Terrier, Benjamin MD, PhD*; Costagliola, Dominique MD, PhD†,‡,§; Besson, Caroline MD, PhD‖,¶,#

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2014 - Volume 67 - Issue 2 - p e86–e87
doi: 10.1097/QAI.0000000000000272
Letters to the Editor
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*Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Université Paris 5 Descartes, Paris, France

Department of Internal Medicine, Hôpital Pitié-Salpétrière

INSERM U943

§Université Paris 6 Pierre et Marie Curie UMR S 943, Paris, France

Université Paris-Sud, UFR Médecine, Paris, France

Hematology and Immunology Department

#Inserm U-1012, Hôpital Bicêtre Le Kremlin Bicêtre, France

Supported by ANRS (French agency for AIDS and viral hepatitis).

The authors have no conflicts of interest to disclose.

To the Editors:

We thank Dr. Chang et al for their interesting comments regarding our work on the characteristics of B-cell lymphomas in HIV/HCV-coinfected patients during the combined antiretroviral therapy (cART) era.1

In our study, we described that 5 of the 6 HIV/HCV-coinfected patients with B-cell non-Hodgkin lymphoma (NHL) from the ANRS CO16 LYMPHOVIR cohort had features of marginal zone/lymphoplasmacytic NHL versus 1 of 33 HIV only infected patients. In addition, all coinfected patients had extranodal involvement. HIV load was below 50 copies per milliliter in 4/6 patients treated by cART for a median duration of 10 years. Finally, a patient with splenic marginal zone lymphoma responded to anti-HCV antiviral therapy like previously reported in HCV-monoinfected individuals.2 These findings led the hypothesis that HCV infection could be associated with antigen-driven B-cell transformation in the context of HIV infection in the cART era.3

Chang et al explored this hypothesis in the Multicenter AIDS cohort study, which enrolled patients from 1984 to 2003. In their series of the 190 NHL cases, 18 (9.5%) were HIV/HCV-coinfected patients and none of them presented with marginal zone/lymphoplasmacytic NHL. Interestingly, all NHL in coinfected patients were diagnosed in the pre-cART era, which strongly differed from our series. In this context of pre-cART era, NHL from coinfected patients exhibited similar features compared with HIV-monoinfected patients and had very low CD4 counts (median, 84//mm3). In contrast, in our series, HIV/HCV-coinfected patients had much higher CD4 counts (median, 449/mm3).

Overall, we definitely agree with Chang et al that the discrepancies observed between the 2 studies, in particular, the absence of marginal zone/lymphoplasmacytic NHL in coinfected patients in their study, is probably explained by the inclusion of patients in the pre-cART era for Chang and in the cART era in our study. Along this line, we agree that our hypothesis that HCV infection could be associated with antigen-driven B-cell transformation seems to be valid in the context of HIV infection in the cART era, but not in the pre-cART era in which the severity of the underlying immunodeficiency is the major risk factor for lymphomagenesis.4

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REFERENCES

1. Terrier B, Costagliola D, Prevot S, et al.. Characteristics of B-cell lymphomas in HIV/HCV-coinfected patients during the combined antiretroviral therapy era: an ANRS CO16 LYMPHOVIR cohort study. J Acquir Immune Defic Syndr. 2013;63:249–253.
2. Hermine O, Lefrere F, Bronowicki JP, et al.. Regression of splenic lymphoma with villous lymphocytes after treatment of hepatitis C virus infection. N Engl J Med. 2002;347:89–94.
3. Capello D, Martini M, Gloghini A, et al.. Molecular analysis of immunoglobulin variable genes in human immunodeficiency virus-related non-Hodgkin's lymphoma reveals implications for disease pathogenesis and histogenesis. Haematologica. 2008;93:1178–1185.
4. Guiguet M, Boue F, Cadranel J, et al.. Effect of immunodeficiency, HIV viral load, and antiretroviral therapy on the risk of individual malignancies (FHDH-ANRS CO4): a prospective cohort study. Lancet Oncol. 2009;10:1152–1159.
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