Primary effusion lymphoma in HIV

Following the widespread use of HAART, malignancy now accounts for nearly 30% of all HIV deaths. Non-AIDS defining malignancies (NADMs) make up a large proportion of this burden, however, AIDS-defining malignancies (ADM) such as non-Hodgkin's Lymphoma (NHL) still makes up nearly 10% of all HIV-deaths. Following recent reclassification by the WHO, Primary effusion lymphoma (PEL), plasmablastic and lymphoma arising in HHV8-associated Castleman's disease make up the lymphomas that occur more frequently in the setting of HIV infection. PEL also referred to as body cavity based lymphoma, accounts for 4% of all HIV associated NHL. PEL presents as malignant effusions of the pleura, pericardium or peritoneum without lymphadenopathy. The pathogenesis is through malignant conversion of lymphoid cells by human herpes virus 8, and evidence of this virus is essential for diagnosis. Other key criteria include presence of common leukocyte marker CD45, but absence of common T-cell and B-cell markers. Prognosis is poor despite treatment with median survival being about 6 months. Standard treatment includes continuation or initiation of HAART and CHOP-like chemotherapy regimens. Novel therapies including use of rituximab, or autologous cell transplant have been used with mixed results. Our case highlights the need to be vigilant when assessing HIV patients with Kaposi's sarcoma for the presence of PEL.