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52. Hematologic Aspects of HIV
Cote TR, Biggar RJ, Rosenberg PS, Devesa SS, Percy C, Yellin FJ, Lemp G, Hardy C, Geodert JJ, and Blattner WA.
Non-Hodgkin's lymphoma among people with AIDS: incidence, presentation and public health burden. AIDS/Cancer study group.
Int J Cancer. 1997 Nov 27; 73(5): 645-650.
Description: This represents the largest of several HIV population surveys describing the public health burden of AIDS-related lymphoma (ARL) and the vastly increased risk of varoius subtypes of non-Hodgkin's lymphoma in this group of patients.
PubMed citation number: 9398040
Ratner L, Lee J, Tang S, Redden D, Hamzeh F, Herndier B, Scadden D, Kaplan L, Ambinder R, Levine A, Harrington W, Grochow L, Flexner C, Tan B, and Straus D
AIDS Malignancy Consortium. Chemotherapy for HIV associated non-Hodgkin's lymphoma in combination with highly active anti-retroviral therapy.
J Clin Oncol. 2001 Apr 15; 19(8): 2171-2178.
Description: This trial demonstrated the safety and effectiveness of combining a non -AZT containing highly active antiretroviral therapy (HAART) regimen with full-dose CHOP chemotherapy and G-CSF support.
PubMed citation number: 11304769
Little RF, Pittaluga S, Grant N, Steinberg SM, Kavlick MF, Mitsuya H, Franchini G, Gutierrez M, Raffeld M, Jaffe ES, Shearer G, Yarchoan R, and Wilson WH.
Highly effective treatment of acquired immunodeficiency syndrome-related lymphoma with dose-adjusted EPOCH: impact of antiretroviral therapy suspension and tumor biology.
Blood. 2003 Jun 15; 101(12): 4653-4659.
Description: This study: 1) demonstrated the safety of withdrawing HAART therapy during chemotherapy (with reinstitution at the completion of chemotherapy); 2) showed remarkable anti-lymphoma activity of dose-adjusted EPOCH; 3) correlated activity of the dose-adjusted EPOCH regimen with the biology of ARL; and 4) demonstrated a shift in the phenotype of ARL in the HAART era, with the more prognostically favorable germinal center B origin lymphomas predominating over the pre-HAART post-germinal center B origin lymphomas.
PubMed citation number: 12609827

Besson C, Goubar A, Gabarre J, Rozenbaum W, Pialoux G, Chatelet FP, Katlama C, Charlotte F, Dupont B, Brousse N, Huerre M, Mikol J, Camparo P, Mokhtari K, Tulliez M, Salmon-Ceron D, Boue F, Costagliola D, and Raphael M.
Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy.
Blood. 2001 Oct 15; 98(8): 2339-2344.
Description: This study demonstrated a significant decrease in the incidence of systemic and primary central nervous system non-Hodgkin's lymphomas in the post-HAART era as well as an improvement in survival from ARL during this time, emphasizing the importance HIV control as part of the treatment of ARL.
PubMed citation number: 11588028

Nador RG, Cesarman E, Chadburn A, Dawson DB, Ansari MQ, Sald J, and Knowles DM.
Primary effusion lymphoma: a distinct clinicopathologic entity associated with the Kaposi's sarcoma-associated herpes virus.
Blood. 1996 Jul 15; 88(2): 645-656.
Description: This study described the existence of a new AIDS-related lymphoma that is strongly associated with human herpes virus-8 (HHV-8) infection, thus suggesting a pathogenic role of HHV-8 in this distinct lymphoma.
PubMed citation number: 8695812
MacMahon EM, Glass JD, Hayward SD,. Mann RB, Becker PS, Charache P, McArthur JC, and Ambinder RF.
Epstein-Barr virus in AIDS-related primary central nervous system lymphoma.
Lancet. 1991 Oct 19(8773); 338: 969-973.
Description: This study demonstrated a 100% association between primary central nervous system lymphoma in AIDS patients and latent EBV infection, thus demonstrating a particularly important role for EBV in this subtype of AIDS-related lymphoma.
PubMed citation number: 1681341
Sullivan PS, Hanson DL, Chu SY, Jones JL, and Ward JW.
Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project.
Blood. 1998 Jan 1; 91(1): 301-308.
Description: The above study is a large epidemiologic study showing that 1) the incidence of anemia increases with more advanced HIV infection; 2) anemia is an independent risk factor for death in HIV patients independent of viral load and CD4 count; and 3) recovery from anemia leads to increased survival.
PubMed citation number: 9414298
Spivak JL, Barnes DC, Fuchs E, and Quinn TC.
Serum immunoreactive erythropoietin in HIV-infected patients.
JAMA. 1989 Jun 2; 261(21): 3104-7.
Description: This study first demonstrated both an inappropriately low production of erythropoietin and a decreased response to erythropoietin in anemic patients with HIV.
PubMed citation number: 2716142
Henry DH, Beall GN, Benson CA, Carey J, Cone LA, Eron LJ, Fiala M, Fischl MA, Gabin SJ, Gottlieb MS, et al.
Recombinant human erythropoietin in the treatment of anemia associated with human immunodeficiency virus (HIV) infection and zidovudine therapy. Overview of four clinical trials.
Ann Intern Med. 1992; 117: 739-748.
Description: This study established the effectiveness of exogenously-administered erythropoietin in increasing mean hemoglobin levels and decreasing transfusion requirements in HIV patients with anemia and endogenous erythropoietin levels < 500.
PubMed citation number: 1416576
Abkowitz JL, Brown KE, Wood RW, Kovach NL, Green SW, and Young NS.
Clinical relevance of parvovirus B19 infection as a cause of anemia in patients with human immunodeficiency virus infection.
J Infect Dis. 1997 Jul; 176(1): 269-273.
Description: This study established parvovirus B19 infection as an important cause of severe anemia (hematocrit < 24) in HIV patients.
PubMed citation number: 9207380
Ann C. Collier, MD; Leslie A. Kalish, ScD; Michael P. Busch, MD, PhD; Terry Gernsheimer, MD; Susan F. Assmann, PhD; Thomas A. Lane, MD; David M. Asmuth, MD; Michael M. Lederman, MD; Edward L. Murphy, MD, MPH; Princy Kumar, MD; Meera Kelley, MD; Timothy P. Flanigan, MD; Deborah K. McMahon, MD; Henry S. Sacks, MD, PhD; Melanie S. Kennedy, MD; Paul V. Holland, MD; for the Viral Activation Transfusion Study Group.
Leukocyte-Reduced Red Blood Cell Transfusions in Patients With Anemia and Human Immunodeficiency Virus Infection. The Viral Activation Transfusion Study: A Randomized Controlled Trial.
JAMA. 2001 Mar 28; 285(12): 1592-1601.
Description: This study refuted the results of earlier, smaller studies and showed that leukocyte-reduced red blood cell transfusions do not lead to improved clinical outcomes as measured by HIV, CMV, and cytokine activation.
PubMed citation number: 11268267
Morris L, Distenfeld A, Amorosi E, and Karpatkin S.
Autoimmune thrombocytopenic purpura in homosexual men.
Ann Intern Med. 1982 Jun; 96(6 part 1): 714-717.
Description: This was the first documented report describing the association of an autoimmune thrombocytopenic purpura in people with HIV infection.
PubMed citation number: 6178333
Ballem PJ, Belzberg A, Devine DV, Lyster D, Spruston B, Chambers H, Doubroff P, and Mikulash K.
Kinetic studies of the mechanism of thrombocytopenia in patients with human immunodeficiency virus infection.
N Engl J Med. 1992 Dec 17; 327(25): 1779-84.
Description: This was the first study of platelet kinetics in thrombocytopenic HIV patients and showed that thrombocytopenia is due to both increased platelet destruction and decreased production and that treatment with AZT leads to increased platelet production.
PubMed citation number: 1435932
Nardi MA, Liu L-X, and Karpatkin S.
GPIIIa-(49-66) is a major pathophysiologically relevant antigenic determinant for anti-platelet GPIIIa of HIV-1-related immunologic thrombocytopenia.
Proc Natl Acad Sci. 1997 Jul; 94(14): 7589-7594.
Description: This study identified the specific epitope on GPIIIa to which anti-platelet antibodies are directed in patients with HIV-related immune thrombocytopenic purpura (ITP) and showed that the anti-GPIIIa antibodies are specific to patients with HIV-related ITP.
PubMed citation number: 9207136
Richman DD, Fischl MA, Grieco MH, Gottlieb MS, Volberding PA, Laskin OL, Leedom JM, Groopman JE, Mildvan D, Hirsch MS, et al.
The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial.
N Engl J Med. 1987 Jul 23 317(4): 192-197.
Description: This was the first report describing substantial hematologic toxicities associated with relatively high doses of AZT for the treatment of AIDS.
PubMed citation number: 3299090
Selected review articles
Volberding PA, Baker KR, Levine AM.
Human immunodeficiency virus hematology. Hematology (Am Soc Hematol Educ Program). 2003:294-313.
PubMed citation number: 14633787

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