INCIDENCE, CLINICAL AND MORPHOOGICAL DESCRIPTION OF MALIGNANT LYMPHOPROLIFERATIVE DISEASES IN PATIENTS WITH VERTICAL TRANSMISSION OF HIV IN RIO DE JANEIRO IN THE POST CART ERA: A MULTICENTER STUDY

With combined antiretroviral therapy (cART), AIDS became a chronic disease, increasing both survival of patients and prevalence of the infection in children. Incidence of cancer in children and teenagers infected with HIV is 5 to 8 times superior when compared to non-infected ones, being non-Hodgkin ymphoma (NHL) the most common type. In Brazil, data about incidence of malignant lymphoproliferative diseases (MLD) in this population are scarce and little is known about the impact of cART over these diseases. The purpose of this study is to evaluate the incidence of MLD in these patients, reclassify the MLD observed according to WHO (2017) and understand the impact of cART in this context. A retrospective cohort of 1.306 pediatric patients infected by vertical transmission of HIV who attended in 6 reference institutions at the city of Rio de Janeiro between 01/1995 and 01/2018 were observed. Data was collected by reviewing follow-up sheets, social service records and charts. Tumor samples were sent to the Pathology Service of HUCFF/UFRJ for reclassification. Based on previous studies, the period was divided according to the use of cART in Brazil: Early cART (1995-1999), incipience; Mid cART (2000-2003), amplification;and Late cART (2004-2018), consolidation of cART. The software IBM SPSS Statistics 21.0 was used. Density of incidence per 1.000 people/year was calculated. Cumulative probability of event was given by Nelson-Aalen estimator. The cohort presented 25 lymphoma cases. The density of incidence was 1,66/1.000 people-year in 23 years and the cumulative probability of global event was 2,95%. The median follow-up time was 13 years (CI = 12,745 – 13,255). The cumulative probability of event was 4,85% in Early, 4,18% in Mid and 0,31% in Late cART (p = 0,005). The Hazard Ratio (HR) between Early and Late cART was 15,471 (CI = 2,021 – 118,277; P = 0,008) and between Mid and Late cART was 13,359 (CI = 1,721 – 103,497; p = 0,013). The analysis of tumor samples showed 4 Hodgkin lymphoma and 21 NH. Among NHL, 19 were of known subtypes, being Burkitt lymphoma the predominant with 12 cases. The other 2 NHL subtypes were unknown. The found data show the efficacy of cART in reducing the incidence of malignant diseases related to HIV in the pediatric population and agree with international literature regarding the morphology of these disorders, bringing robust and unprecedented results to the comprehension of MLD spectrum in this population in Brazil.