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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
People living with HIV have a raised risk of aggressive lymphomas, driven by immune suppression and viruses such as Epstein-Barr virus. The transformation of the last two decades is that, with antiretroviral therapy continued through treatment, these lymphomas are treated with the same full-dose chemotherapy and antibody regimens as in anyone else, with similar chances of cure.
HIV-associated lymphomas are mostly aggressive B-cell lymphomas: diffuse large B-cell lymphoma (including immunoblastic and CNS variants), Burkitt lymphoma, and two entities almost specific to immunosuppression, primary effusion lymphoma (HHV-8-driven, presenting as effusions without a mass) and plasmablastic lymphoma (EBV-associated, often oral). Primary CNS lymphoma in HIV is uniformly EBV-positive and occurs at very low CD4 counts. Classical Hodgkin lymphoma is also several-fold more common in people with HIV and, unlike NHL, its incidence has not declined with antiretroviral therapy. Pathogenesis combines loss of immune surveillance of EBV and HHV-8, chronic B-cell activation, and the same oncogenic events seen in immunocompetent patients (MYC translocations in Burkitt, BCL6 rearrangements).
The pre-1996 approach of dose-reduced chemotherapy has been replaced by full-dose, curative-intent therapy alongside antiretroviral therapy, with attention to drug interactions (ritonavir- and cobicistat-boosted regimens interfere with vinca alkaloids and other agents) and infection prophylaxis. The AIDS Malignancy Consortium (AMC) trials established that rituximab is safe and beneficial when CD4 counts exceed 50 cells per microlitre (AMC 034), that R-CHOP or dose-adjusted EPOCH-R cures HIV-associated DLBCL at rates approaching those in HIV-negative patients, and that intensive Burkitt regimens or DA-EPOCH-R are effective in HIV-associated Burkitt lymphoma. Autologous transplant for relapse is feasible (BMT CTN 0803 / AMC 071), and CAR-T therapy has been given safely to people with HIV in case series and is now permitted in most CAR-T trials, reversing decades of routine exclusion. Hodgkin lymphoma is treated with ABVD or brentuximab-based regimens as in the general population.
| Setting | Approach | Guideline |
|---|---|---|
| HIV-associated DLBCL | R-CHOP or dose-adjusted EPOCH-R at full dose with concurrent antiretroviral therapy (avoiding boosted protease inhibitors or cobicistat where possible), G-CSF support and opportunistic-infection prophylaxis; CNS prophylaxis by risk. | NCCN Category 2A |
| HIV-associated Burkitt lymphoma | Intensive Burkitt regimens (CODOX-M/IVAC with rituximab) in fit patients, or DA-EPOCH-R (low-intensity variant studied in HIV); intrathecal prophylaxis. | not mapped |
| Primary effusion and plasmablastic lymphoma | CHOP or EPOCH-based chemotherapy with antiretroviral therapy; bortezomib-containing regimens for plasmablastic; clinical trials (pomalidomide, daratumumab, anti-IL-6). | not mapped |
| Relapsed or refractory | Salvage chemotherapy and autologous transplant (feasible with controlled HIV; BMT CTN 0803); CD19 CAR-T on the same criteria as HIV-negative patients; bispecific antibodies emerging. | not mapped |
| HIV-associated Hodgkin lymphoma | ABVD or brentuximab-based regimens as for the general population, with antiretroviral therapy. | not mapped |