Methods: Peripheral blood CD4 cell counts and serum HIV RNA viral load (VL) were measured in patients receiving chemotherapy for AIDS-related lymphoma. Twenty-one patients receiving BEMOP/CA (nine) or CDE (12) chemotherapy were recruited. The antiretroviral therapy, which was not altered during chemotherapy, was PI-based HAART (10), NNRTI-based HAART (eight), dual nucleosides (one) or none (two).
Results: The mean pretreatment CD4 count was 191/μL (SEM = 41) and VL was 127 000 copies/mL (SEM = 42 000), 66% had CD4 < 200/μL (PCP prophylaxis level) and 19% CD4 < 50/μL (MAC prophylaxis level). By the third month of chemotherapy, the mean CD4 count had halved to 102/μL (SEM = 19) and the mean VL was 40 000 (SEM = 17 000), 85% had CD4 < 200/μL and 40% CD4 < 50/μL. None of these changes achieves statistical significance (P > 0.05). During the chemotherapy there was no change in the percentage of lymphocytes that were CD4 cells. One month after the chemotherapy the mean CD4 count had risen to 202/μL (SEM = 47), almost exactly the same as the pretreatment value, and the VL was 121 000 copies/mL (SEM = 60 000).
Conclusions: The changes in CD4 count during chemotherapy reflect changes in the absolute lymphocyte count rather than selective loss. After chemotherapy, the CD4 count recovers without changing antiretroviral therapy. Thus, the chemotherapy appears to have only a temporary effect on the CD4 count. There are important implications for OI prophylaxis.