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T cell lymphoma in HIV+
Mar 21, 2001

A good friend was diagnosed as HIV positive 2 months ago during evaluation for swollen groin glands that turned out the be treatable T-cell lymphoma (not felt to be AIDS related). He has not had other symptoms and feels quite well.

His two recent CD4 counts were 303 and 450. His viral loads were over 300,000/ml each time and he was begun in HAART which he has been tolerating. I do not know his response to treat yet, but he seems to tolerate the pills well.

He has begun 6 cycles of CHOP chemotherapy that is supposed to be well tolerated and only mildly and transiently bone marrow suppressive. He takes the white cell boaster neupogen when his counts are low. His doctor has given him levoquin for the high fever he had during the first cycle that went away (opportunitic infection?).

He has received the flu shot, pneumonia vaccine and was negative for TB on skin testing. His blood tests show that he had remote syphilis (he was treated more than 20 years ago).

Based on this story, does he seem to have AIDS? Should he been on any other infection preventions at this time for thrush, PCP, toxo, etc.?

Response from Dr. Feinberg

T cell lymphomas have been described in HIV+s, although they are uncommon. T cell lymphoma is the hallmark of HTLV-I infection, a virus that is (distantly) related to HIV. So I wouldn't be so quick to say that your friend does not have AIDS.

But even if the T cell lymphoma were totally unrelated to his HIV, he still needs PCP prophylxis merely on the basis of receiving combination chemotherapy, which is itself a risk for PCP. WE routinely provide PCP prophylaxis for AIDS patients undergoing chempotherapy for B cell lymphomas, which are typical in HIV+s, regardless of what their Cd4 cell count is.

Otherwise, it sounds like he is getting excellent care. I would also make sure he gets tested for hepatitis B&C.


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