Comparison of baseline lymphoma and HIV characteristics in Malawi before and after implementation of universal antiretroviral therapy

• Published in: PloS one Vol. 17; no. 9; p. e0273408
• Main Authors: Gondwe, Yolanda, Kudowa, Evaristar, Tomoka, Tamiwe, Kasonkanji, Edwards D., Kaimila, Bongani, Zuze, Takondwa, Mumba, Noel, Kimani, Stephen, Mulenga, Maurice, Chimzimu, Fred, Kampani, Coxcilly, Randall, Cara, Lilly, Amy, Gopal, Satish, Fedoriw, Yuri, Painschab, Matthew
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.09.2022; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; B-cell lymphoma; Biology and Life Sciences; Biopsy; Burkitt Lymphoma - drug therapy; Burkitt Lymphoma - epidemiology; Burkitt's lymphoma; Cancer therapies; CD4 antigen; CD4 Lymphocyte Count; Complications and side effects; Data analysis; Diagnosis; Drug therapy; Enrollments; Epidemiology; High income; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV Infections - drug therapy; HIV Infections - epidemiology; Hodgkin Disease - drug therapy; Hodgkin Disease - epidemiology; Hodgkin Disease - pathology; Hodgkin's disease; Human immunodeficiency virus; Humans; Immune system; Immunoproliferative diseases; Lymphocytes; Lymphocytes B; Lymphocytes T; Lymphoma; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - epidemiology; Malawi - epidemiology; Medical diagnosis; Medicine and Health Sciences; Non-Hodgkin's lymphoma; Non-Hodgkin's lymphomas; Patient outcomes; Patients; People and Places; Population; Ribonucleic acid; Risk factors; RNA; Trends; Viruses; Malawi; South Africa; Uganda; United States > US; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0273408

Access to antiretroviral therapy (ART) led to epidemiological changes in human immunodeficiency virus (HIV) associated lymphoma in high-income countries such as reductions in diffuse large B-cell lymphoma (DLBCL) and stable or increased Hodgkin lymphoma (HL) and Burkitt lymphoma (BL). In 2016, Malawi implemented a universal ART (UART) policy, expanding ART eligibility to all persons living with HIV (PLWH). We compare the distribution of lymphoma subtypes and baseline HIV and prognostic characteristics for lymphoma patients in Malawi before and after implementation of UART. We enrolled patients with pathologically confirmed incident lymphoproliferative disorders into a observational clinical cohort. At diagnosis, a comprehensive clinicopathological evaluation was performed. Of 412 participants, 156 (38%) were pre-UART (2013-June 2016) and 256 (62%) post-UART (July 2016–2020). HIV prevalence was 50% in both groups. The most common pre-UART diagnoses were DLBCL [75 (48%)], low-grade non-Hodgkin lymphoma (NHL) [19 (12%)], HL [17 (11%)] and, BL [13 (8%)]. For post-UART they were DLBCL [111 (43%)], NHL [28 (11%)], BL [27 11%)] and, HL [20 (8%)]. Among PLWH, 44 (57%) pre-UART initiated ART prior to lymphoma diagnosis compared to 99 (78%) post-UART (p = 0.02). HIV-ribonucleic acid was suppressed <1000 copies/mL in 56% (33/59) pre-UART and 71% (73/103) post-UART (p = 0.05). CD4 T-cell counts were similar for both groups. We observed similar findings in the subset of participants with DLBCL. Overall, there were no significant changes in incident lymphoma subtypes (p = 0.61) after implementation of UART, but HIV was better controlled. Emerging trends bear monitoring and may have implications for prognosis and health system priority setting. Trial registration: ClinicalTrials.gov identifier: NCT02835911 .