Reactive haemophagocytic syndrome in 58 HIV-1-infected patients: clinical features, underlying diseases and prognosis

To describe features of reactive haemophagocytic syndrome (RHS) in HIV-1-infected adult patients. To compare characteristics of patients with malignancy-associated RHS and infection-associated RHS. Retrospective study in three departments of Infectious Diseases/Internal Medicine at three French tert...

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Veröffentlicht in:AIDS (London) 2010-06, Vol.24 (9), p.1299-1306
Hauptverfasser: FARDET, Laurence, LAMBOTTE, Olivier, MOLINA, Jean-Michel, MARTINEZ, Valérie, MEYNARD, Jean-Luc, KAMOUH, Wassim, GALICIER, Lionel, MARZAC, Christophe, DE LABARTHE, Adrienne, CABANE, Jean, LEBBE, Céleste, COPPO, Paul
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container_issue 9
container_start_page 1299
container_title AIDS (London)
container_volume 24
creator FARDET, Laurence
LAMBOTTE, Olivier
MOLINA, Jean-Michel
MARTINEZ, Valérie
MEYNARD, Jean-Luc
KAMOUH, Wassim
GALICIER, Lionel
MARZAC, Christophe
DE LABARTHE, Adrienne
CABANE, Jean
LEBBE, Céleste
COPPO, Paul
description To describe features of reactive haemophagocytic syndrome (RHS) in HIV-1-infected adult patients. To compare characteristics of patients with malignancy-associated RHS and infection-associated RHS. Retrospective study in three departments of Infectious Diseases/Internal Medicine at three French tertiary centres. Medical charts of HIV-1-infected adult patients and RHS seen between January 2006 and December 2007 were reviewed. Demographic, clinical and laboratory data obtained at the time of RHS episode were compared between patients with malignancy-associated RHS and infection-associated RHS using non-parametric tests. The overall survival was assessed using the Kaplan-Meier method. Fifty-eight HIV-1-infected patients were diagnosed with RHS [certain RHS n = 43, possible RHS n = 15, median (range) age 42 (23-85) years, men 76%]. At time of RHS, the median duration of HIV infection was 4 (0-22) years and 57% received HAART. The median CD4 lymphocyte count was 91 (2-387)/microl and 35% of patients had a plasma HIV-1 RNA less than 50 copies/ml. Underlying haemopathy/malignancy (Hodgkin lymphoma n = 10) or infection (tuberculosis n = 9, cytomegalovirus infection n = 5) were evidenced for 31 and 23 patients, respectively. Patients with haemopathy/malignancy-associated RHS presented more frequently with splenomegaly (97 vs. 70%, P < 0.01), lower aspartate aminotransferase (36 vs. 84 UI/l, P < 0.01) and lactate dehydrogenase (530 vs. 911 UI/l, P < 0.01) levels and CD8 cell count (234 vs. 588/microl, P < 0.01). Eighteen (31%) patients died. The overall survival was not statistically different between the two groups (P = 0.68). In the HAART era, RHS is frequently associated with underlying haemopathy/malignancy, especially Hodgkin lymphoma. The prognosis remains poor but seems, however, better than in the pre-HAART era.
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To compare characteristics of patients with malignancy-associated RHS and infection-associated RHS. Retrospective study in three departments of Infectious Diseases/Internal Medicine at three French tertiary centres. Medical charts of HIV-1-infected adult patients and RHS seen between January 2006 and December 2007 were reviewed. Demographic, clinical and laboratory data obtained at the time of RHS episode were compared between patients with malignancy-associated RHS and infection-associated RHS using non-parametric tests. The overall survival was assessed using the Kaplan-Meier method. Fifty-eight HIV-1-infected patients were diagnosed with RHS [certain RHS n = 43, possible RHS n = 15, median (range) age 42 (23-85) years, men 76%]. At time of RHS, the median duration of HIV infection was 4 (0-22) years and 57% received HAART. The median CD4 lymphocyte count was 91 (2-387)/microl and 35% of patients had a plasma HIV-1 RNA less than 50 copies/ml. Underlying haemopathy/malignancy (Hodgkin lymphoma n = 10) or infection (tuberculosis n = 9, cytomegalovirus infection n = 5) were evidenced for 31 and 23 patients, respectively. Patients with haemopathy/malignancy-associated RHS presented more frequently with splenomegaly (97 vs. 70%, P &lt; 0.01), lower aspartate aminotransferase (36 vs. 84 UI/l, P &lt; 0.01) and lactate dehydrogenase (530 vs. 911 UI/l, P &lt; 0.01) levels and CD8 cell count (234 vs. 588/microl, P &lt; 0.01). Eighteen (31%) patients died. The overall survival was not statistically different between the two groups (P = 0.68). In the HAART era, RHS is frequently associated with underlying haemopathy/malignancy, especially Hodgkin lymphoma. 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Immunoglobulinopathies ; Immunopathology ; Infection ; Infectious diseases ; Kaplan-Meier Estimate ; L-Lactate dehydrogenase ; Lymphohistiocytosis, Hemophagocytic - complications ; Lymphohistiocytosis, Hemophagocytic - mortality ; Lymphohistiocytosis, Hemophagocytic - virology ; Male ; Malignancy ; Medical sciences ; Middle Aged ; Mycobacterium ; Other diseases. Hematologic involvement in other diseases ; Prognosis ; Retrospective Studies ; RNA ; Splenomegaly ; Survival ; Tuberculosis ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. 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To compare characteristics of patients with malignancy-associated RHS and infection-associated RHS. Retrospective study in three departments of Infectious Diseases/Internal Medicine at three French tertiary centres. Medical charts of HIV-1-infected adult patients and RHS seen between January 2006 and December 2007 were reviewed. Demographic, clinical and laboratory data obtained at the time of RHS episode were compared between patients with malignancy-associated RHS and infection-associated RHS using non-parametric tests. The overall survival was assessed using the Kaplan-Meier method. Fifty-eight HIV-1-infected patients were diagnosed with RHS [certain RHS n = 43, possible RHS n = 15, median (range) age 42 (23-85) years, men 76%]. At time of RHS, the median duration of HIV infection was 4 (0-22) years and 57% received HAART. The median CD4 lymphocyte count was 91 (2-387)/microl and 35% of patients had a plasma HIV-1 RNA less than 50 copies/ml. Underlying haemopathy/malignancy (Hodgkin lymphoma n = 10) or infection (tuberculosis n = 9, cytomegalovirus infection n = 5) were evidenced for 31 and 23 patients, respectively. Patients with haemopathy/malignancy-associated RHS presented more frequently with splenomegaly (97 vs. 70%, P &lt; 0.01), lower aspartate aminotransferase (36 vs. 84 UI/l, P &lt; 0.01) and lactate dehydrogenase (530 vs. 911 UI/l, P &lt; 0.01) levels and CD8 cell count (234 vs. 588/microl, P &lt; 0.01). Eighteen (31%) patients died. The overall survival was not statistically different between the two groups (P = 0.68). In the HAART era, RHS is frequently associated with underlying haemopathy/malignancy, especially Hodgkin lymphoma. The prognosis remains poor but seems, however, better than in the pre-HAART era.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>AIDS-Related Opportunistic Infections - mortality</subject><subject>AIDS-Related Opportunistic Infections - virology</subject><subject>AIDS/HIV</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Aspartate aminotransferase</subject><subject>Biological and medical sciences</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>CD8 antigen</subject><subject>Cell number</subject><subject>Cytomegalovirus</subject><subject>Data processing</subject><subject>Demography</subject><subject>Female</subject><subject>France</subject><subject>Hematologic and hematopoietic diseases</subject><subject>highly active antiretroviral therapy</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - mortality</subject><subject>HIV-1 - immunology</subject><subject>Hodgkin's disease</subject><subject>Human immunodeficiency virus 1</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infection</subject><subject>Infectious diseases</subject><subject>Kaplan-Meier Estimate</subject><subject>L-Lactate dehydrogenase</subject><subject>Lymphohistiocytosis, Hemophagocytic - complications</subject><subject>Lymphohistiocytosis, Hemophagocytic - mortality</subject><subject>Lymphohistiocytosis, Hemophagocytic - virology</subject><subject>Male</subject><subject>Malignancy</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mycobacterium</subject><subject>Other diseases. Hematologic involvement in other diseases</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>RNA</subject><subject>Splenomegaly</subject><subject>Survival</subject><subject>Tuberculosis</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>Young Adult</subject><issn>0269-9370</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1rFTEUhoNY7LX6D0SyETdOezJJJom7Uj9aKBSluB3OJCe3kZnM7WSmcP-9U3pVcOPqbJ7nvPC-jL0RcCrAmbN7DKfQgZAkayulI627Z2wjlJGV1kY8ZxuoG1c5aeCYvSzlJwBosPYFO65Bawey2bDlO6Gf0wPxO6Rh3N3hdvT7OXle9jlM40A8Za4tv7z6UYkq5Uh-psB3OCfKc_nIfZ9y8tjzSDgvE5UPfMmBpn6f8paHVAgLFY55laZxm8eSyit2FLEv9PpwT9jtl8-3F5fV9c3Xq4vz68orC3MlPUSQXWx8MAGVQxI1KKmtdI335GqrGqyFE8J3JloTQbtgA1olguxQnrD3T2_X4PuFytwOqXjqe8w0LqU1qgGx1iD_T0opoVbOrKR6Iv00ljJRbHdTGnDatwLax2Hab-ef2n-HWbW3h4ClGyj8kX4vsQLvDgCWtc04Yfap_OVqa6xRTv4CWwGYew</recordid><startdate>20100601</startdate><enddate>20100601</enddate><creator>FARDET, Laurence</creator><creator>LAMBOTTE, Olivier</creator><creator>MOLINA, Jean-Michel</creator><creator>MARTINEZ, Valérie</creator><creator>MEYNARD, Jean-Luc</creator><creator>KAMOUH, Wassim</creator><creator>GALICIER, Lionel</creator><creator>MARZAC, Christophe</creator><creator>DE LABARTHE, Adrienne</creator><creator>CABANE, Jean</creator><creator>LEBBE, Céleste</creator><creator>COPPO, Paul</creator><general>Lippincott Williams &amp; Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QL</scope><scope>7T5</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope></search><sort><creationdate>20100601</creationdate><title>Reactive haemophagocytic syndrome in 58 HIV-1-infected patients: clinical features, underlying diseases and prognosis</title><author>FARDET, Laurence ; LAMBOTTE, Olivier ; MOLINA, Jean-Michel ; MARTINEZ, Valérie ; MEYNARD, Jean-Luc ; KAMOUH, Wassim ; GALICIER, Lionel ; MARZAC, Christophe ; DE LABARTHE, Adrienne ; CABANE, Jean ; LEBBE, Céleste ; COPPO, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-3c0f03bf6cd7da49ae1204358396cce92846a21911cb7f87f059d8da841d3ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>AIDS-Related Opportunistic Infections - mortality</topic><topic>AIDS-Related Opportunistic Infections - virology</topic><topic>AIDS/HIV</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Aspartate aminotransferase</topic><topic>Biological and medical sciences</topic><topic>CD4 antigen</topic><topic>CD4 Lymphocyte Count</topic><topic>CD8 antigen</topic><topic>Cell number</topic><topic>Cytomegalovirus</topic><topic>Data processing</topic><topic>Demography</topic><topic>Female</topic><topic>France</topic><topic>Hematologic and hematopoietic diseases</topic><topic>highly active antiretroviral therapy</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - mortality</topic><topic>HIV-1 - immunology</topic><topic>Hodgkin's disease</topic><topic>Human immunodeficiency virus 1</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunodeficiencies</topic><topic>Immunodeficiencies. Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Infection</topic><topic>Infectious diseases</topic><topic>Kaplan-Meier Estimate</topic><topic>L-Lactate dehydrogenase</topic><topic>Lymphohistiocytosis, Hemophagocytic - complications</topic><topic>Lymphohistiocytosis, Hemophagocytic - mortality</topic><topic>Lymphohistiocytosis, Hemophagocytic - virology</topic><topic>Male</topic><topic>Malignancy</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mycobacterium</topic><topic>Other diseases. Hematologic involvement in other diseases</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>RNA</topic><topic>Splenomegaly</topic><topic>Survival</topic><topic>Tuberculosis</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. 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To compare characteristics of patients with malignancy-associated RHS and infection-associated RHS. Retrospective study in three departments of Infectious Diseases/Internal Medicine at three French tertiary centres. Medical charts of HIV-1-infected adult patients and RHS seen between January 2006 and December 2007 were reviewed. Demographic, clinical and laboratory data obtained at the time of RHS episode were compared between patients with malignancy-associated RHS and infection-associated RHS using non-parametric tests. The overall survival was assessed using the Kaplan-Meier method. Fifty-eight HIV-1-infected patients were diagnosed with RHS [certain RHS n = 43, possible RHS n = 15, median (range) age 42 (23-85) years, men 76%]. At time of RHS, the median duration of HIV infection was 4 (0-22) years and 57% received HAART. The median CD4 lymphocyte count was 91 (2-387)/microl and 35% of patients had a plasma HIV-1 RNA less than 50 copies/ml. Underlying haemopathy/malignancy (Hodgkin lymphoma n = 10) or infection (tuberculosis n = 9, cytomegalovirus infection n = 5) were evidenced for 31 and 23 patients, respectively. Patients with haemopathy/malignancy-associated RHS presented more frequently with splenomegaly (97 vs. 70%, P &lt; 0.01), lower aspartate aminotransferase (36 vs. 84 UI/l, P &lt; 0.01) and lactate dehydrogenase (530 vs. 911 UI/l, P &lt; 0.01) levels and CD8 cell count (234 vs. 588/microl, P &lt; 0.01). Eighteen (31%) patients died. The overall survival was not statistically different between the two groups (P = 0.68). In the HAART era, RHS is frequently associated with underlying haemopathy/malignancy, especially Hodgkin lymphoma. The prognosis remains poor but seems, however, better than in the pre-HAART era.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams &amp; Wilkins</pub><pmid>20559036</pmid><doi>10.1097/qad.0b013e328339e55b</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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ispartof AIDS (London), 2010-06, Vol.24 (9), p.1299-1306
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source MEDLINE; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals
subjects Adult
Age
Aged
Aged, 80 and over
AIDS-Related Opportunistic Infections - mortality
AIDS-Related Opportunistic Infections - virology
AIDS/HIV
Antiretroviral Therapy, Highly Active
Aspartate aminotransferase
Biological and medical sciences
CD4 antigen
CD4 Lymphocyte Count
CD8 antigen
Cell number
Cytomegalovirus
Data processing
Demography
Female
France
Hematologic and hematopoietic diseases
highly active antiretroviral therapy
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - mortality
HIV-1 - immunology
Hodgkin's disease
Human immunodeficiency virus 1
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infection
Infectious diseases
Kaplan-Meier Estimate
L-Lactate dehydrogenase
Lymphohistiocytosis, Hemophagocytic - complications
Lymphohistiocytosis, Hemophagocytic - mortality
Lymphohistiocytosis, Hemophagocytic - virology
Male
Malignancy
Medical sciences
Middle Aged
Mycobacterium
Other diseases. Hematologic involvement in other diseases
Prognosis
Retrospective Studies
RNA
Splenomegaly
Survival
Tuberculosis
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Young Adult
title Reactive haemophagocytic syndrome in 58 HIV-1-infected patients: clinical features, underlying diseases and prognosis
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