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Use of Rituxan in CHOP treatment
Sep 18, 2001

My oncologist wants to start me on chemotherapy in about two weeks using the CHOP therapy. He wants to use a drug called ituxan as part of the therapy, but has not used with any HIV patients. What are the effects or benefits of using this drug for an HIV person (viral load of 5000, CD4 cell of 450), no medications.

Response from Dr. Dezube

Although you are focussing on the Rituxan, I must first address the use of anti-retroviral medications. Although a viral load of 5000 and a CD4 count of 450 might not qualify in some people's books as a reason for starting HIV drugs, I would STRONGLY urge you to do so now that you have been diagnosed with lymphoma. There are good data which suggest that patients on chemotherapy do much better when they are also taking HIV drugs. I typically use the zerit/epivir/sustiva regimen which goes well with chemotherapy. The HIV drugs are MUCH more important than Rituxan.

Rituxan is an antibody which targets a surface structure on your tumor cells. In HIV-negative patients, there are some data to suggest that Rituxan improves the outcome of patients receiving CHOP; these data however are preliminary. In HIV positive patients, there are simply no data to know whether or not to use Rituxan. The National Cancer Institute (NCI) is currently running a clinical trial just to address this question in HIV-positive folks. Until the results are in, we just don't know the answer to your question. I personally do not give Rituxan to my HIV positive patients outside of a trial; I encourage my HIV positive patients to enroll in the NCI trial. If your oncologist wants to give you Rituxan, then this is a very reasonable approach, though it's not based on solid data.

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