Background: The incidence of lymphomas in the Western Cape, a province of South Africa, with a population of 5 million and a HIV prevalence of 17% is undocumented. Antiretroviral therapy (ART) was introduced into the public patient sector in 2004 with 34% estimated coverage by 2010. People living with HIV (PLWH) have a significant increased risk of developing HIV-related lymphoma (HRL). Therefore, HRL would be expected to increase but retard with introduction of ART. The pattern of the impact of HIV and effect of introduction of ART is investigated.
Methods: We reviewed all patients diagnosed with malignant lymphoma (ML) from the Tygerberg Hospital catchments area in the Western Cape of South Africa for years 2002-2011. In this time frame 900 cases of ML were identified of which 710 were HIV negative and 190 HIV positive. ML were sub-typed according to WHO classification, based on morphology, molecular and immunophenotypic platforms.
Results: ML cases increased steadily with each year from 2002 to 2011. Despite the introduction of an aggressive ART roll out program in 2004, HRL increased steadily from 4% in 2002 to 28% in 2011 with a profile of subtypes differing from the HIV negative cases. There is a predominance of Diffuse Large B Cell Lymphoma and Burkitt Lymphoma in the HIV positive cohort. The range of the CD4 count at presentation in a smaller cohort studied between 2010 and 2011 was from 20 to 620, with an average count of 150.
Conclusion: These findings are in contrast to the observed pattern of reduced incidence of HRL in the developed world with the introduction of ART. This warrants evaluation in the manner and timing of introduction of ART in South Africa.
(C) 2013 Lippincott Williams & Wilkins, Inc.