Predictors of survival after a diagnosis of non-Hodgkin lymphoma in a resource-limited setting: a retrospective study on the impact of HIV infection and its treatment

J Acquir Immune Defic Syndr. 2011 Apr;56(4):312-9. doi: 10.1097/QAI.0b013e31820c011a.


Objective: We examined factors associated with survival among patients with newly diagnosed non-Hodgkin lymphoma (NHL) in Uganda.

Methods: Information was abstracted from medical records for all NHL patients >13 years of age at the Uganda Cancer Institute between January 2004 and August 2008. Cox proportional hazard models were used to identify predictors of NHL survival.

Results: One hundred sixty patients with NHL were identified; 51 (31.9%) were known to be HIV positive. Overall, 154 patients had records sufficient for further analysis. The median person-time observed was 104 days (interquartile range 26-222). Median survival after presentation among those whose mortality status was confirmed was 61 days (interquartile range 25-203). HIV-positive patients receiving antiretroviral therapy had survival rates approximating those of HIV-negative persons, but the adjusted hazard of death was significantly elevated among HIV-positive patients not receiving antiretroviral therapy [adjusted hazard ratio (HR) 8.99, P < 0.001] compared with HIV-negative patients. Both B-symptoms (HR 2.08, P = 0.05) and female gender (HR 1.72, P = 0.05) were associated with higher mortality.

Conclusions: In Uganda, overall survival of NHL patients is poor, and predictors of survival differed from those described in resource-rich regions. HIV is a common comorbidity to NHL, and its lack of treatment was among the strongest predictors of mortality. Strategies are needed for optimal management of HIV-infected individuals with cancer in resource-limited settings.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / methods*
  • Developing Countries
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • Humans
  • Lymphoma, Non-Hodgkin / epidemiology*
  • Lymphoma, Non-Hodgkin / mortality*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Analysis
  • Uganda / epidemiology
  • Young Adult


  • Anti-HIV Agents