Clinical Characteristics and Prognostic Factors of HIV-Positive Patients With Lymphoma in the Poverty Region of China: A Real-World Multicenter Analysis

Abstract

Background: People living with HIV (PLWHIV) are at increased risk of Hodgkin and non-Hodgkin lymphoma compared with HIV-negative individuals. However, high-quality epidemiological data for lymphoma among PLWHIV from low-income and middle-income countries are scarce, especially in South China. This retrospective study aimed to better define the clinical characteristics, outcomes, and prognostic factors of HIV-associated lymphoma patients in Guangxi and Guangdong provinces of China in the highly active antiretroviral therapy (HAART) era. Methods: We performed a pooled analysis from existing databases of 143 patients with HIV-positive lymphoma between January 2013 and June 2020 from three hospitals in South China. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Univariable and multivariable Cox proportional hazard models were performed to identify the association of patient-, lymphoma- and HIV-specific variables with the outcomes progression-free survival (PFS) and overall survival (OS). Results: Of all 143 HIV-positive lymphoma patients, diffuse large B cell lymphoma (DLBCL) was the most common subtype identified (81.8%). The median age was 49 years (IQR 18–79), and 118 patients (82.5%) were male. The mean CD4 T-cell count was 185.5 cells/µL (IQR 3–1089), and 86 (60.1%) patients were receiving HAART at enrollment. Opportunistic infections (OIs) were reported in 40 (28.0%) patients. Seventy-seven (53.8%) patients had stage I/II lymphoma, and the Eastern Cooperative Oncology Group performance status was 0 or 1 in 87 (60.8%) patients. Information on elevated lactate dehydrogenase (LDH) and positive CD20 was available for 72% (103/143) and 96.0% (48/50), respectively. A total of 65.8% (77/117) of DLBCL patients received EPOCH- (dose-adjusted etoposide, vincristine, cyclophosphamide, prednisone, and doxorubicin) or CHOP-based (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimens. The 1-year PFS and 1-year OS were 32.98% and 43.62% in non-Hodgkin's lymphoma (NHL) patients and 32.18% and 41.40% in DLBCL patients, respectively. Advanced age and elevated LDH were significant predictors of the outcome in both HIV-associated NHL and DLBCL, and the influence of other factors waxed and waned. A lower CD4/CD8 ratio was an independent poor predictor for 1-year OS in HIV-associated NHL but not for DLBCL. Conclusions: In our population, HIV-positive patients with lymphoma presented aggressive characteristics and exhibited poor survival outcomes, even in the modern HAART era. Effective HIV-directed therapies reduced the impact of HIV-associated prognostic factors on outcomes; however, lymphoma-related factors, such as age and LDH, were found to be key independent predictors for HIV-associated lymphoma.

Diffuse Large B-Cell Lymphoma in the Public-Sector of Johannesburg, South Africa, in the Era of Widescale Antiretroviral Therapy Use

“…Another factor which has been shown to negatively affect DLBCL survival elsewhere is associated oncogenic viral infection, particularly EBV, [38][39][40] hepatitis B (HBV), 41,42 and hepatitis C (HCV). 18,[43][44][45] Here, we showed a hepatitis B seropositivity rate among the PLWH of 11.1%, which is similar to that reported in 2 studies from Nanjing China, 18,22 higher than that reported in Shanghai (7%), 46 and lower than that reported in the USA and in another study from Nanjing (;20%). 45,47 However, HBV seropositivity had no significant impact on survival.…”

“…The frequency of documented extranodal involvement in PLWH was somewhat higher than that reported in one study from the WC of SA (;50%) 9 and another study from the United States of America (USA) (;40%), 11 but comparable to several other reports of HIV-DLBCL from other parts of the world 13,[18][19][20][21][22] at both timepoints (;70%), with involvement of the GIT being the most common extranodal site. Interestingly, extranodal involvement was observed in a similar proportion of HIV negative patients, with the predominant extranodal site being the bone marrow in this group.…”