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Letter to the editors regarding the paper: Prognostic factors in HIV-positive patients with non-Hodgkin lymphoma: a Peruvian experience


Non-Hodgkin Lymphoma (NHL) is a neoplasm associated with a group of malignancies called AIDs-Defining Malignancies (ADMs) in Human-Immunodeficiency Virus (HIV) -patients. Similar to the case of NHL in Latin America, particularly in Peru, the amount of research done on others ADMs is limited, especially in the case of Kaposi’s Sarcoma (KS). Prior investigations have talked about the great potential risk that represents this illness in latin american population, but topics as prognosis factors are yet to be well defined. In this letter, we address the importance of investigation in this area and include previously reported data that may enlighten the current national standpoint.

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We have read with great interest the article previously presented in this journal regarding the prognosis factors in Human-Immunodeficiency Virus (HIV) -patients with non-Hodgkin Lymphoma (NHL) [1]. This study encouraged us to elaborate on the importance of investigation about this type of malignancies, including another relevant neoplasm such as Kaposi’s Sarcoma (KS).

As previously mentioned by Cuellar et al., the number of researches done in Latin American countries regarding AIDs-Defining Malignancies (ADMs) is marginal [1]. Likewise, the author affirmed that this is the first study of its sort made in Peruvian population and the first concerning survival in NHL in Latin American population, defining relevant prognosis factors such as being ART-naïve, having low albumin levels, and the tumor staging [1]. As evidence, the last research regarding NHL and its prognostic factors was made in 2009 by Rezende et al. [2]; there were not following investigations that comprised these topics until Cuellar [1]. This observation is relevant because it provides a perspective of the research status in other illnesses such as KS, where there is no precedent study respecting survival or prognostic factors. Therefore, the lack of investigation in this area appears to affect NHL and other ADMs.

Delving in KS, it is a neoplasm related with a viral etiology caused by both Herpesvirus type 8 (HHV-8) and HIV [3,4,5]. In Peru, according to prior investigations, the incidence of HHV-8 on mixed population is relatively high; with a report by Mohanna et al. who finds a prevalence of 56,25% in a study with 128 blood donors non-HIV carriers [6,7,8]. With no actual published information, we can only infer that Peru may have a high prevalence of patients that may be at risk of developing SK, with the presence of its prognostic factors, or currently are manifesting the disease by the information stated beforehand.

It has been reported that prognostic factors in NHL are similar to KS, probably because of their relationship with HIV [4]. In spite of this information, it has been established that the prognostic factors in KS are not well defined; stating that even CD4 count, crucial information in an average HIV-patient, does not represent a significant factor in the prognosis of KS [9]. This may occur because of the changes in treatment, the introduction of Highly Active Antiretroviral Therapy (HAART), and the lack of survival research [9].

Finally, we held in high regards your research in this kind of population and subjects, both which tends have investigations that do not bring much data. Because of the importance of your study, we considered important to broaden this kind of interest in the same area, so we can contribute bringing more information to the literature through longitudinal studies, like prospective or retrospective cohort studies.



AIDs-Defining Malignancies


Highly Active Antiretroviral Therapy


Herpesvirus type 8


Human-Immunodeficiency Virus


Kaposi’s Sarcoma


Non-Hodgkin Lymphoma


  1. Cuellar LE, Anampa-Guzmán A, Holguín AM, Velarde J, Portillo-Alvarez D, Zuñiga-Ninaquispe MA, et al. Prognostic factors in HIV-positive patients with non-Hodgkin lymphoma: a Peruvian experience. Infect Agent Cancer [Internet]. 2018 31 [cited 2018 Aug 17];13(1):27. Available from:

  2. Rezende REF, Mantelmacher M, Ferreira S da C, Hyppólito EB, Machado AA, Ardengh JC, et al. Clinical, endoscopic and prognostic aspects of primary gastric non-hodgkin’s lymphoma associated with acquired immunodeficiency syndrome. Braz J Infect Dis [Internet]. 2009 [cited 2018 Nov 1];13(1):2–4. Available from:

  3. Hymes K, Greene J, Marcus A, William D, Cheung T, Prose N, et al. KAPOSI’S SARCOMA IN HOMOSEXUAL MEN—A REPORT OF EIGHT CASES. Lancet [Internet]. 1981 19 [cited 2018 Aug 23];318(8247):598–600. Available from:

  4. Monforte A d’Arminio, Abrams D, Pradier C, Weber R, Reiss P, Bonnet F, et al. HIV-induced immunodeficiency and mortality from AIDS-defining and non-AIDS-defining malignancies. AIDS [Internet]. 2008 [cited 2018 Aug 30];22(16):2143–2153. Available from:

  5. Di Lorenzo G, Konstantinopoulos PA, Pantanowitz L, Di Trolio R, De Placido S, Dezube BJ. Management of AIDS-related Kaposi’s sarcoma. Lancet Oncol [Internet]. 2007 [cited 2018 Aug 28];8(2):167–176. Available from:

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  8. Mohanna S, Portillo JA, Carriquiry G, Vidal J, Ferrufino JC, Sanchez J, et al. Human herpesvirus-8 in Peruvian blood donors: a population with hyperendemic disease? Clin Infect Dis [Internet]. 2007 [cited 2018 Aug 28];44(4):558–561. Available from:

  9. Nasti G, Talamini R, Antinori A, Martellotta F, Jacchetti G, Chiodo F, et al. AIDS-Related Kaposi’s Sarcoma: Evaluation of Potential New Prognostic Factors and Assessment of the AIDS Clinical Trial Group Staging System in the HAART Era—the Italian Cooperative Group on AIDS and Tumors and the Italian Cohort of Patients Naïve From Antiretrovirals. J Clin Oncol [Internet]. 2003 [cited 2018 Oct 30];21(15):2876–2882. Available from:

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DQP and MPRC were the major contributors to the writing of the article. AJL was responsible for the structural design of the article and its contents distribution. All authors read and approved the final manuscript.

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Correspondence to Mirtha P. Rivera-Castillo.

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Rivera-Castillo, M.P., Quispe-Pineda, D. & Lucchetti, A.J. Letter to the editors regarding the paper: Prognostic factors in HIV-positive patients with non-Hodgkin lymphoma: a Peruvian experience. Infect Agents Cancer 13, 39 (2018).

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