A Comparison of Clinical Profile and Treatment Outcome of Hodgkin’s Lymphoma in Tanzania According to HIV Status during the HAART era

Abstract

Abstract Background The incidence of Hodgkin’s lymphoma (HL) in HIV-positive individuals is approximately 19X more than in HIV-negative persons. Most HIV-HL patients present at an advanced stage (Ann Arbor stage III-IV), have “B” symptoms and extranodal involvement. HAART's development has led to a significant change in the natural history and risk stratification of HIV-HL. Therefore, this study aimed to determine differences in clinicopathological and survival patterns of HL among individuals with and without HIV disease in Tanzania in the HAART era. Methodology This hospital-based retrospective cohort study was conducted at the ORCI, Dar-Es-Salaam, Tanzania. Chi-square and Fisher’s exact tests were used to compare proportions. Student t-test was used to compare means. The log-rank test was applied to the variables in univariate analysis to identify factors that predict survival. The factors that were significant in univariate analysis were then analyzed in multivariate fashion using a Cox regression model. Results 83 patients with HL were recruited, and the prevalence of HIV-positive status was 27.7%. Most of the patients with HIV-HL had an age of more than 30 years (73.9%), while most of the non-HIV-HL patients had an age of less than 30 years (63.3%) (P = 0.02). The 2-year OS rate for HIV-HL was 34%, while that for non-HIV-HL was 67%. Among the HIV-HL patients, predictors of a poorer outcome were a CD4 count ≤ 200 cells/mm3 (P = 0.05), lack of HAART use (P = 0.00), and the use of HAART for ≤ 10 months (P = 0.00). Conclusion The prevalence of HIV-HL was 27.7% among HL patients. HIV positivity is still a poor prognostic factor in our setting, especially for patients not on HAART, on HAART for less than ten or ten months, or with a low CD4 count below 200 cells/mm3.Patients with HIV-HL were older and had higher LDH levels, whereas patients with non-HIV-HL were younger and had low LDH levels.