Short Communication: CD4 Count and HIV RNA Trends for HIV-Associated Lymphoproliferative Disorders in Malawi

AIDS Res Hum Retroviruses. 2017 Oct;33(10):1045-1047. doi: 10.1089/AID.2017.0081. Epub 2017 Jun 26.


Given scarce data from sub-Saharan Africa (SSA), we sought to describe CD4 count and HIV RNA trends over time among patients with HIV-positive lymphoproliferative disorders in Malawi. We prospectively enrolled HIV-positive individuals with pathologically confirmed lymphoproliferative disorders between 2013 and 2016. Chemotherapy was standardized with concurrent antiretroviral therapy (ART). We assessed CD4 count and HIV RNA at baseline and every 6 months for up to 2 years. Of 72 HIV-positive patients, 59 had non-Hodgkin lymphoma (NHL), 5 classical Hodgkin lymphoma (CHL), and 8 multicentric Castleman disease (MCD). Median age was 43 years (range 23-64). Fifty-five patients (76%) were on ART at enrollment for a median 47 months (range 1-387), with median CD4 count of 138 cells/μl (range 2-2,235) and median HIV RNA of 2.2 log10copies/ml (range 0.3-7.3). MCD patients had longer median ART durations, higher median CD4 counts, and lower median HIV RNA at baseline than NHL or CHL patients. CD4 count and HIV RNA steadily improved during follow-up, with different patterns in different histological groups. Twelve-month overall survival (OS) was 55% [95% confidence interval (CI) 42%-66%]. There were trends toward baseline CD4 count <100 cells/μl and HIV RNA >2.0 log10copies/ml being associated with worse OS. However, CD4 count and HIV RNA improvements during follow-up were independent of possible effects on OS. Distribution of HIV-positive lymphoproliferative disorders may change with continued ART scale-up in SSA. Chemotherapy and concurrent ART can lead to good immunological and virological outcomes.

Keywords: Hodgkin lymphoma; multicentric Castleman disease; non-Hodgkin lymphoma; sub-Saharan Africa.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bleomycin / therapeutic use
  • CD4 Lymphocyte Count / trends*
  • Castleman Disease / complications*
  • Castleman Disease / drug therapy
  • Cyclophosphamide / therapeutic use
  • Dacarbazine / therapeutic use
  • Doxorubicin / therapeutic use
  • Etoposide / therapeutic use
  • HIV Infections / drug therapy
  • HIV Infections / etiology*
  • HIV Infections / immunology*
  • HIV-1 / drug effects
  • Hodgkin Disease / complications*
  • Hodgkin Disease / drug therapy
  • Humans
  • Lymphoma, Non-Hodgkin / complications*
  • Lymphoma, Non-Hodgkin / drug therapy
  • Malawi
  • Middle Aged
  • Prednisone / therapeutic use
  • Prospective Studies
  • RNA, Viral / blood*
  • Vinblastine / therapeutic use
  • Vincristine / therapeutic use


  • Anti-HIV Agents
  • RNA, Viral
  • Bleomycin
  • Vincristine
  • Vinblastine
  • Etoposide
  • Dacarbazine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • ABVD protocol
  • CHOP protocol
  • Multi-centric Castleman's Disease