Lymphoma Imaging in HIV and Non-HIV Patients: A Retrospective Cross-Sectional Study With Clinical and Pathological Correlation

Background: Patients with Human Immunodeficiency Virus (HIV)have an atypical imaging pattern of lymphoma. There is paucity of literature on differences in tumor volume or burden of disease amongst HIV positive patients compared with HIV negative patients and how this correlates with clinicopathological parameters of aggressiveness and prognosis. Methods: This was a retrospective cross-sectional study of patients with non-Hodgkin lymphoma which were categorized into HIV positive and HIV negative. The tumor burden, disease sites, international prognostic score and Ki-67 index were recorded. Continuous variables were analyzed using the Kruskal Wallis test and categorical variables with Fisher’s Exact test. Results: Out of the 92 patients with non-Hodgkin lymphoma, 51.1% were HIV positive with a median age of 45.0 years. The median sum of product diameters used to measure tumor burden was 102.6 [IQR: 51.7, 173.1] with no significant difference seen between the 2 groups. The extranodal disease was significantly higher in the HIV positive group (85.1%) while exclusive nodal disease was seen predominantly in the non-HIV group (66.7%) (P < .001). Complete treatment response was higher in the non-HIV group 54.5% compared to 20.9% for the HIV group (P < .001). More HIV positive patients succumbed, 37.2% compared to the 4.5% for non-HIV patients (P < .001). Conclusion: HIV-related lymphoma remains a poorly understood subset. Although there was no significant difference in overall tumor burden between HIV positive and negative patients, extranodal disease was significantly higher in the HIV positive patients. Furthermore, the clinical prognostication score and Ki-67 which apply well for HIV-negative patients may not apply for HIV-related lymphoma.