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Changing Pattern of Lymphoma Subgroups at a Tertiary Academic Complex in a High-Prevalence HIV Setting: A South African Perspective

Wiggill, Tracey M MBBCh, MMed (Haem)*; Mantina, Hamakwa MD*; Willem, Pascale MD, PhD*; Perner, Yvonne MBBCh, FCPath (Anat Path)†; Stevens, Wendy S MBBCh, MMed (Haem), FCPath (Haem)*

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e31820bb06a
Epidemiology and Prevention
Abstract

Background: HIV infection has been associated with an increased risk of non-Hodgkin lymphoma, particularly in the first world. Despite the high burden of HIV infection in sub-Saharan regions, published data on HIV and malignancies are sparse from these areas.

Materials and Methods: We recently published data on lymphomas diagnosed from January 2004 to December 2006, at a single center in Johannesburg, to serve as a baseline for long-term comparison during the period of highly active antiretroviral therapy rollout. We report a retrospective analysis of the follow-up data collected from January 2007 to December 2009 at the Johannesburg academic hospital complex (Gauteng, South Africa).

Results: There were 2225 new diagnoses of lymphoproliferative disorders made during 2007-2009 as compared with 1897 cases diagnosed during 2004-2006. A significant increase in both high-grade B-cell lymphomas and Hodgkin lymphoma was documented during 2007-2009. This was associated with a statistically significant increase in HIV prevalence in those tested (from 44.3% in 2004-2006 to 62.0% in 2007-2009). HIV-positive patients presented at a statistically significantly younger median age and showed a relative overrepresentation of females when compared with HIV-negative patients. HIV-positive patients were diagnosed at later stages of HIV infection when compared with patients in the first world.

Conclusions: The pattern of lymphoma subtypes and the demographics of the patients diagnosed have altered in association with significantly increased HIV prevalence. These changes have important public health implications. In particular, scale-up and earlier access to highly active antiretroviral therapy is essential with continued monitoring as access to therapy improves.

Author Information

From the Departments of *Molecular Medicine and Haematology and †Anatomical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa.

Received for publication October 19, 2010; accepted December 15, 2010.

T.M.W. is the recipient of a Fogarty International Centre Scholarship (National Institutes of Health: D43 TW000010-21S1) and has received a Cancer Research Grant from CANSA (Cancer Association of South Africa).

The authors have no conflicts of interest to disclose.

Correspondence to: Tracey M. Wiggill, MBBCh, MMed (Haem), Room 3B18, 3rd floor Wits Medical School, 7 York Road, Parktown, Johannesburg, 2000, South Africa. e-mail: tracey.wiggill@nhls.ac.za.

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© 2011 Lippincott Williams & Wilkins, Inc.