If your immune system is down, you have a much higher than average chance of developing a lymphoma. And nobody knows this better than people with acquired immune deficiency syndrome, better known as AIDS. People with AIDS get lymphoma at 200 times the normal rate. But that is changing.

A study reported from France in the Oct. 15 issue of Blood (Vol. 98, No.6: 2339-2344) found that the rate of lymphoma in patients with AIDS is decreasing. The researchers studied the rate of lymphomas in French AIDS patients. They looked at the records of over 80,000 AIDS patients and compared the lymphoma rates in these patients in the years 1993 and 1994 with the rates in 1997 and 1998.

The two periods were chosen because between those times a new treatment for AIDS was introduced. This treatment, called highly active antiretroviral therapy, or HAART has been very effective in treating AIDS.

The new therapy, sometimes called the anti-AIDS cocktail, is actually a combination of several drugs that kill HIV, the virus responsible for AIDS. One major effects of this new treatment is that it reduces many of the infectious complications of AIDS such as severe viral and fungal infections.

But, it also has an effect on lymphomas. The French researchers found that the new AIDS cocktail cut the lymphoma rate by half. The main reason for this drop in lymphoma rates seems to be that HAART blocks the immune deficiency state from occurring. In the study, the lymphoma rate was still high in those patients who were severely immune deficient. There were just fewer of them.

Another even more important change was that the rate of primary brain lymphoma dropped by two-thirds. This difficult lymphoma is very disabling because it occurs in the brain. It interferes with many brain functions and patients quickly become bedridden and totally dependent on others for care.

Chemotherapy and radiation have rarely been able to reverse this and patients usually die quickly from this lymphoma. The drop in this lymphoma also seemed due to the better-preserved immune system after the new antiviral therapy.

The final question the researchers asked was whether lymphomas in AIDS patients were as severe as they had been in the past. In the past, the diagnosis of lymphoma in an AIDS patient was akin to a death sentence. Almost half the patients died in six months. The good news is that the French doctors found that in the era after HAART, their survival has tripled.

The authors conclude "the profile of AIDS-related lymphomas has changed dramatically since the era of HAART…" This may be the first full report on the change in AIDS-related lymphomas in an entire country since the new therapy was developed and there is reason to think that similar changes have occurred in US AIDS patients.