Primary cerebral NHL occurs in patients with advanced immunodeficiency and presents with features of a space-occupying lesions or raised intracranial pressure.  Scanning demonstrates one or more mass lesions. Definitive diagnosis is made on biopsy.

Systemic NHL can occur at any time during HIV infection. The incidence increases as immunodeficiency progresses. Biopsies show intermediate and high grade tumour. The disease is usually widespread at the time of diagnosis. There is a high incidence of involvement of extranodal sites including the gastrointestinal tract, central nervous system, bone marrow and liver. Severe constitutional symptoms include fevers, night sweats and weight loss.

Dexamethasone is the first line of treatment for primary cerebral lymphoma. Radiotherapy may be given if the patient is not too debilitated. Radiotherapy is not indicated for those who are comatose.

Symptoms control in systemic NHL may be alleviated using combination therapy. This may relieve pain and stop weight loss in many patients. Chemotherapy is given in reduced dosage because of pre-existing myelosuppressive medications. G-CSF may reduce the incidence of severe neutropenia and the risk of secondary infection. Unfortunately, most remissions are not lasting and rapid relapse and progression is the norm. Radiotherapy is used for localized disease as well as to treat areas of residual or bulk disease in patients treated with chemotherapy.

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