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.