The Impact of HIV Status on Clinical Profile and Survival Among Patients With Diffuse Large B Cell Lymphoma in a Resource- Constrained Setting in the Haart Era

Abstract Background: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease encompassing a wide range of lymphomas, making diagnosis and treatment difficult. DLBCL accounts for half of non-Hodgkin lymphoma cases in people living with HIV/AIDS (PLWHA) and is the most common form of lymphoma in PLWHA. Even with the rollout of highly active antiretroviral therapy (HAART) and the availability of Rituximab, the treatment of DLBCL remains subpar in resource-constrained settings like Tanzania. This study aimed to identify differences in clinical profile and treatment outcomes between HIV-positive and HIV-negative DLBCL cases during the HAART era. Methods: A retrospective review of medical charts of adults with a confirmed HIV infection status treated for DLBCL with chemotherapy +/- Rituximab and consolidation radiotherapy between January 2018 and December 2019 at Ocean Road Cancer Institute (ORCI) in Dar es salaam, Tanzania, was conducted. The clinical profile and overall survival for HIV-positive DLBCL were compared to that of HIV-negative DLBCL. Vital status at three years were determined. Survival functions were estimated using the Kaplan-Meier methodology. The equality of survival functions were assessed using Log-rank tests and Cox regression analysis to identify risk factors for mortality. Results: One hundred and eleven eligible medical charts were identified. This was a cohort of black Africans with a median age of 46 (IQR: 18–81) with a 57.3% male gender distribution and 44% HIV prevalence. Overall survival (OS) at 12, 24, and 36 months for the population was 58%, 50%, and 38%, respectively, for the entire cohort. The clinical features for HIV-negative and HIV-positive DLBCL cases were similar except for the age at diagnosis, health insurance status, initial hemoglobin, functional status, and the use of salvage chemotherapy, whereby patients with HIV-positive DLBCL were more likely to be young, not have health insurance, have a low Karnofsky Performance score, have a low hemoglobin level, and be given salvage chemotherapy compared to HIV-negative DLBCL. HIV status was not associated with a reduction in 3 years overall OS [adjusted hazard ratio (aHR)1.2, (95% CI 0.7–2.1)]. Consolidation radiotherapy use was not associated with a reduction in 3 years overall OS [adjusted hazard ratio (aHR)0.2, (95% CI 0.03–1.6]. Rituximab use was associated with a marginally statistically significant increase in mortality [adjusted hazard ratio (aHR)0.53, (95% CI 0.3–1.02)]. Risk factors of three years mortality was low hemoglobin level [aHR 0.46, (95% CI 0.3–0.8)] and high IPI score [aHR 0.46, (0.2–0.8)]. Conclusion: Patients with HIV-positive DLBCL were more likely to be young, not have health insurance, have a low Karnofsky Performance score, have a low hemoglobin level, and be given salvage chemotherapy compared to HIV-negative DLBCL. HIV status and consolidation radiotherapy were not predictors of OS in the entire cohort. Rituximab use was associated with a poor 3 years OS in Tanzania patients with DLBCL especially those with HIV positive DLBCL. Low hemoglobin levels and high IPI scores were predictors of mortality.