Ten years ago I had non-Hodgkin's lymphoma (NHL). My CD4 count was in the 800's. Treated with CHOP chemotherapy and radiation and returned to work 8/93.

In the Spring of 1995 I became very fatigued, CD4 cells remained high & viral load was over 9 million.

Crixivan, Zerit, and 3TC came along to save me soon after Neuropathy and lipodystrophy were constant companions as well as fatique. My CD4 cells have remained in the 600-800 range all these years and my viral load was all over the place; 400 in the beginning, 13K and 20K for a few years, 80K a few times, then only 4500 right before I switched earlier this year.

I switched to Sustiva, Ziagen and Viread and kept the 3TC. Having problems with Sustiva so starting Nivirapine today to replace it in 2 weeks.

I just freaked out reading your column. Do you think its possible that the PI class (perhaps Crixivan) conveyed some sort of protection from NHL - possibly making the virus less fit - less able to cause a NHL again (my doc and I have mused about this over the years). I am surprised to read about people with VL of 70 and T cells of 400 getting NHL.

Also I volunteer for an AIDS hotline in NYC and have heard stories of people who switched from mid-90's combinations, achieved viral suppression and yet got NHL again. I'm getting scared. It took me 5 years to recover the first time! Any thoughts - even random ones appreciated?

Thank you - this is such valuable work.

Frank

Dear Frank, Your original lymphoma was 10 years ago. It would be most unusual, though not impossible, for this lymphoma to recur so late. I obviously can not give you any guarantee. You are concerned that switching classes of HIV drugs can spark recurrence of your lymphoma. I am not aware of any data which would suggest that this could or might occur. I personally have switched most of my lymphoma patients to the newer regimens given their improved tolerability and ease of administration. So, in short, if your health provider feels that a class switch is in your best interest, I would go for it. Even if, heaven forbid, that your lymphoma were to recur, I would find it hard to believe that it is related to the class switch.