Impact of HIV Infection on the Clinical Presentation and Survival of Non-Hodgkin Lymphoma: A Prospective Observational Study From Botswana

Abstract

Purpose: Botswana has a high prevalence of human immunodeficiency virus (HIV) infection. Currently, there is little data regarding the sociodemographic factors, clinical characteristics, and outcomes of non-Hodgkin lymphoma (NHL)—an acquired immune deficiency syndrome (AIDS)-defining cancer—in the country. Patients and Methods: This study utilized a prospective cancer registry to identify patients with a new diagnosis of NHL, reporting for specialty cancer care at 3 hospitals in Botswana between October, 2010 and August, 2016. Treatment patterns and clinical outcomes were analyzed. Results: One hundred four patients with a new diagnosis of NHL were enrolled into this study, 72% of whom had HIV infection. Compared to HIV-uninfected patients, HIV-infected patients were younger (median age: 53.9 vs. 39.1 years, p = 0.001) and more likely to present with an aggressive subtype of NHL (65.5% vs. 84.0%, p = 0.008). All HIV-infected patients received combined antiretroviral therapy (ART) throughout the course of the study, and similar chemotherapeutic regimens were recommended for all patients, regardless of subtype or HIV-status (6 to 8 cycles of CHOP or R-CHOP). There was no difference in 1-year mortality among HIV-uninfected and HIV-infected patients (unadjusted analysis: 52.9% vs. 37.1%, HR: 0.73, p = 0.33; adjusted analysis: HR: 0.57, p = 0.14). However, when compared to a cohort of patients in the United States matched by subtype, stage, age, sex, and race, patients in Botswana fared worse (1-year mortality: 22.8% vs. 46.3%, HR: 1.89, p = 0.001). Conclusion: Among patients with NHL reporting for specialty cancer care in Botswana, there is no association between HIV status and 1-year survival.