Remission of a primary effusion lymphoma with initiation of highly active antiretroviral therapy and antiviral therapy in a previously untreated HIV-positive patient
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Department of Medicine, Memorial Sloan Kettering Cancer Center, United States
Submission date: 2019-11-13
Final revision date: 2020-06-06
Acceptance date: 2021-03-02
Publication date: 2021-09-30
HIV & AIDS Review 2021;20(3):223-225
Primary effusion lymphoma (PEL) is a rare, high-grade large B-cell lymphoma characteristically associated with human herpes virus (HHV) 8 and often with coinfection by Epstein-Barr virus (EBV). Most patients present in the context of immunodeficiency, commonly with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). These lymphomas are often confined to the pleural, pericardial, or peritoneal spaces as lymphomatous effusions with no evidence of solid tumor. No standard line of treatment exists for patients with PEL and the prognosis remains poor.

Case description:
We describe here the case of a 47-year-old man with a history of HIV managed with observation alone due to a low viral load and CD4 count of ~1000 cells/µl who presented with fatigue, dyspnea on exertion, and orthopnea discovered to be secondary to a new pericardial effusion. Cytology revealed an HHV-8 and EBV-associated primary effusion lymphoma. Given the new diagnosis, the patient started highly active antiretroviral therapy (HAART) and antiviral therapy and subsequently reached complete remission with no further treatment. Five years later, the patient remains with no evidence of disease.

Although the prognosis for PEL is usually poor, the remission of disease and lack of recurrent symptoms suggest that HAART and antiviral therapy alone in this patient was effective in controlling the lymphoma. After two years on antiviral therapy, the patient remains disease free.

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