HIV/AIDS-related lymphoma: perspective from a regional cancer center in India

BACKGROUND: India has the third largest population of people living with HIV/AIDS (PLHA). Lymphoma is the second most common malignancy among PLHA. However, data are lacking regarding HIV/AIDS-related lymphoma (ARL) in India. This study evaluated the epidemiology and clinical outcomes of ARL from a regional cancer center in India. METHODS: This retrospective analysis included cases of ARL between March 2011 and September 2017. Data were obtained from patient record files for the assessment of epidemiology and clinical outcomes. Statistical analysis was performed using GraphPad Prism 6. Comparisons of subtype-specific survivals were performed using log-rank tests. RESULTS: Of 1,226 lymphoma cases, 80 (6.5%) were ARL. Details were available for 70 patients. The median age at diagnosis was 40.5 (9–74) years with a male:female ratio of 2:1. AIDS-defining lymphomas (ADL) constituted 78.6% of cases, while 21.4% had non-AIDS defining lymphoma (NADL). The mean CD4 counts were 193.15±92.85 and 301.93±107.95 cells/µL, respectively (t-test; P=0.0002). Extranodal involvement was present in 55.7%, B symptoms were reported in 60%, and lactate dehydrogenase (LDH) was elevated in 64.3% of patients. The median overall survival times were 6 months for plasmablastic lymphoma (PBL), 23 months for diffuse large B-cell lymphoma (DLBCL), and was not reached for Hodgkin's lymphoma (log-rank test; P=0.0011). Other histological subtype cases were too few to draw meaningful survival outcomes. CONCLUSION: ARL is a heterogeneous disease. Histologic subtype is a major determinant of the clinical outcome. ADL has significantly lower CD4 counts than those of NADL. There is an urgent and unmet need for uniform management guidelines for improving outcomes in this under-represented patient population.