HIV and Hodgkin Lymphoma Survival: A Prospective Study in Botswana

Abstract

PURPOSE People living with HIV (PLWH) experience increased risk of Hodgkin lymphoma (HL) despite effective initiation of antiretroviral therapy (ART). In high-income countries, outcomes following HIV HL have been reported to be non-differential, or inferior for PLWH. We sought to assess the effect of HIV on HL survival in Botswana, an African country with a generalized HIV epidemic and high ART coverage, to describe a context more reflective of global HIV populations. PATIENTS AND METHODS In the Thabatse Cancer Cohort, consenting participants initiating treatment for HL at one of four cancer centers in Botswana were enrolled from 2010 to 2020. Patients were followed quarterly for up to 5 years. The impact of HIV on survival following treatment initiation was assessed using an inverse probability–weighted Cox marginal structural model adjusted for age, performance status, and disease stage. RESULTS Seventy-eight new HL cases were enrolled, 47 (60%) were PLWH and 31 (40%) were HIV-uninfected. Baseline characteristics were similar between groups. The majority (61%) of patients presented with regional disease (stage I or II) with no statistically significant difference by HIV status ( P = .38). Nearly all (87%) PLWH participants were on ART before their HL diagnosis (median ART duration 42 months), and median CD4 count was 413 cells/μL (interquartile range 253-691). Survival, in unadjusted analyses, was lower among patients without HIV compared with PLWH (log rank P = .021). In adjusted analysis, HIV infection was not significantly associated with survival in inverse probability–weighted Cox model (hazard ratio 0.43; 95% CI, 0.16 to 1.16; P = .094). CONCLUSION In this cohort of patients treated for HL in Botswana, survival in PLWH (87% on long-standing ART) was at least as good as in individuals without HIV.

Use of granulocyte colony-stimulating factor in patients with chemotherapy-induced neutropaenia

“…HIV-associated lymphoma (HAL) is a common malignancy in South Africa (Wang, Jun & Yao, 2022 ), although there are limited data from South Africa on HL (Rapiti et al 2022 ). This study found HIV a comorbid disease in most patients treated for lymphomas which is in line with published literature (Moahi et al 2022 ).…”

“…With the introduction of highly active antiretroviral therapy (HAART) and the expected improved life expectancy, malignancies have become the leading cause of disease and death in people with HIV. Although HL is not considered an AIDS-defining disease, the incidence of HL in HIV-infected individuals is higher compared to the general population (Moahi et al 2022 ). More than 28% of HIV-related deaths are ascribed to malignant tumours and AIDS-associated lymphomas are found in more than 40% of HIV-infected individuals (Berhan, Bayleyegn & Getaneh 2022 ).…”

Impact of the HIV infection in Hodgkin lymphoma individuals: A protocol for systematic review and meta analysis

“…However, other studies do not confirm any significant difference between the mortality of HIV-infected and non-infected HL patients. [ 5 , 27 ]…”

“…However, other studies do not confirm any significant difference between the mortality of HIV-infected and non-infected HL patients. [5,27] According to Olszewski et al, [26] the frequency of relapses among HL seropositive patients is associated with a T CD4 + count below 200, indicating severe immunodeficiency. Furthermore, Castillo et al [9] conclude that a T CD4 + count < 200 was an independent adverse prognostic factor for disease-free survival and overall survival.…”

HIV-related lymphomas

“…Good results have also been reported with BEACOP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone) with a complete response rate of 86% and 2-year overall survival of 91% in PLWH with advanced Hodgkin lymphoma. However, BEA-COPP is rarely used in frontline therapy because of its high toxicity (dose reduction/delay > 50%, TMR 6%) [6,32].…”