Human Immunodeficiency Virus Infection and Hodgkin's Lymphoma in South Africa: An Emerging Problem

Abstract

Hodgkin's lymphoma (HL) occurs with increasing frequency in human-immunodeficiency-virus-(HIV-) infected individuals. The natural history and behaviour of HIV-HL is different, being more atypical and aggressive. The association between HIV and HL appears to be primarily EBV driven. HAART use does not significantly impact on the incidence of HL. Indeed, the risk of HL has increased in the post-HAART era. However, the advent of HAART has brought renewed hope, allowing standard therapeutic options to be used more optimally, with better treatment outcomes. Despite the renewed optimism, the overall survival of HIV-HL patients remains less favourable than that in HIV-seronegative patients. This is particularly true in sub-Saharan Africa, where there is a significant burden of HIV/AIDS and where more than half the patients are HAART naive at diagnosis of HL. The similarities and differences of a South African cohort of HIV-HL are presented in this paper.

Dual targeting of the thioredoxin and glutathione systems in cancer and HIV

“…It should be emphasized that HIV/AIDS is associated with multiple types of cancer (103), and although the introduction of ART has led to a dramatic improvement in the prognosis of HIV infection, the incidence of cancer in HIVinfected patients has remained high. This is particularly evident in countries with a high incidence of HIV such as South Africa, where HIV and lymphoma comorbidity is a huge societal problem (132,133). Clinical trials of Trx and GSH pathway inhibitors in individuals affected by HIV and lymphoma should be considered.…”

The utility of bone marrow sampling in the diagnosis and staging of lymphoma in South Africa

“…A high rate of TB co‐infection has been reported in HIV+ HL locally, but the prevalence of TB in other subtypes and in HIV‐negative patients is unclear. Despite screening many of the lymphoma cases with lymphohistiocytic aggregates and granulomas for AFB, only 1 positive case was demonstrated.…”

Meeting the challenge of hematologic malignancies in sub-Saharan Africa

“…8 Similarly, reports from centers in Kenya, South Africa, and Tanzania all suggest increasing NHL burden since the onset of the HIV epidemic, [9][10][11] with some suggestion that HL is also increasing. 12 Incidence trends for leukemia and multiple myeloma are less clear. However, increasing NHL and HL incidence suggest that GLOBOCAN 2030 projections are significantly underestimated and that lymphoma will increase as a proportional contributor to overall cancer burden in the coming decades.…”

“…Consistent increases in NHL, and to a lesser extent HL, have been noted across the region since the onset of the HIV epidemic, and HIV prevalence among NHL and HL patients in many settings ranges from 30% to 70%. 10,12,[32][33][34] In resource-rich countries, clinical trials and observational cohorts have demonstrated comparable outcomes for HIVassociated NHL and HL to patients without HIV, [35][36][37] whereas others have found HIV to be independently associated with mortality. 38 There are limited data examining the impact of HIV on NHL survival in sub-Saharan Africa, although studies suggest that concurrent ART may render survival similar to patients without HIV.…”