27th June 2023

Non-Hodgkin’s lymphoma

People living with HIV are at 100 times greater risk of developing Non-Hodgkin’s Lymphoma (NHL) than the general population. In the context of known HIV infection, non-Hodgkin’s lymphoma is an AIDS-defining malignancy, with 1 in 5 people with HIV developing this. Patients with AIDS-related lymphoma are more likely to develop high-grade B-cell lymphomas. The development of AIDS-related lymphoma is likely due to a combination of mechanisms:

• Loss of immunity, especially of antigen presentation cells
• Cytokine release causing B-cell activation
• Infection including EBV and human herpes virus-8
• HIV gene products (e.g. Tat) are oncogenic within B-cells

Risk factors for non-Hodgkin lymphoma in HIV include:

• Lower CD4+ T-cell count and higher HIV viral load
• Increased age
• Male sex
• Epstein-Barr virus exposure increases the risk for aggressive B-cell non-Hodgkin lymphoma.

People with HIV are more likely to present with more advanced non-Hodgkin lymphoma than other patients, with involvement of more distant sites.

Presenting features may include systemic ‘B-symptom’ type features:

• Fevers
• Night sweats
• Weight loss

Examination will likewise demonstrate clinical features in keeping with haematological malignancy:

• Splenomegaly or hepatosplenomegaly
• Rash
• Lymphadenopathy

Management is related to the cell type of the cancer involved:

• AIDS-related lymphoma is managed with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP)
• Methotrexate may be given in addition
• Rituximab-based chemotherapy regimens may also be used
• Burkitt’s lymphoma is also treated with chemotherapy

Prognosis is generally poor, with relapse common. HAART improves outcomes with this condition.