Clinical Characteristics And Outcomes In HIV-Associated Diffuse Large B-Cell Lymphoma In Kenya: A Retrospective Single-Centre Study
Authors: Oyiro Peter , Nyagol Joshua , Mohamed Ezzi , Yatich Robert , Abinya Nicholas Othieno 
Published: January 2025

Background: There are sparse data in patients with human immunodeficiency virus related diffuse large b cell
lymphoma from real-world settings, especially where access to newer targeted therapies is limited.
Aim: Therefore, we analysed the characteristics and outcomes of patients with HIV-associated DLBCL from The
Kenyatta National Teaching and referral Hospital, Nairobi, Kenya.
Methods: This was a single institution, retrospective cohort study of patients with Diffuse Large B Cell Lymphoma
in HIV diagnosed between January 2012 and December 2019 and treated with combination chemotherapy. The
main objectives were to characterise the clinical-pathological features and estimate progression-free survival
(PFS) and overall survival (OS) from the time of diagnosis.
Results: A total of 82 patients were recruited into the study. Over half 48 (57.8%) were males, while the females
were 34 (42.2%) of the study population. Age range, followed with mean. The mean age of the population was
43.9 years (SD = 13.7) interquartile range of 34-56. Median age was 43 with range between 17-71 years. The
mean age for the females was 43±11 years while that for the males was 44±12years. The male to female ratio
was 1.4:1. Fourt nine 49 (59.8%) were classified as Germinal Center DLBCL while 32(39.0%) were nongerminal center type.
Twenty-seven patients (32.9%) had HIV-associated DLBCL; 18(21.9%) had germinal centre while 9(10.9%) were
of the non-germinal centre subtype. Most patients with HIV had extranodal disease (71%) with a significant
p=0.01, B-symptoms 78% p=0.003, Bone marrow involvement 63% p=0.01 and poorer ECOG performance
status p=0.05. There was also a trend towards higher ki-67 at 79% in HIV associated DLBCL compared to 71 in
those who were HIV negative though was not statistically significant p=0.056. In this study, patients who were
HIV negative tended to have advanced disease at presentation. There was difference between disease bulk and
CNS involvement at presentation between the two groups. The median CD4+ T cell count was 86/µl, and 24
patients were already on combination antiretroviral therapy (cART) treatment at diagnosis of DLBCL.
Local treatment included CHOP and R-CHOP with or without intrathecal methotrexate. The second line
treatment included R-ICE, ICE or DHAP.
At a median follow-up of 18 months, of the 34 patients evaluated at the end of treatment, the overall mean survival
time was 43.1 (95% CI 20.7 – 65.6) months, while the overall median survival time was 29.0 (95% CI 13.8 –
44.2) months. The mean survival time was 56.7 (95% CI 10.9 – 102.5) months, with the overall median survival
time of 48.0 (95% CI 8.2 – 87.8) months for the HIV positive patients while the mean survival time was 30.0 (95%
CI 22.9 – 37.1) months, with an overall median survival time of 28.0 (95% CI 24.1 – 31.9) months for the HIV
negative patients.
There were no statistical differences in the survival times between the two groups as assessed by the Log Rank
test (p=0.384). Conclusion In our population, patients with HIV-associated DLBCL presented with aggressive characteristics, even in the modern cART era but exhibited no difference in survival outcomes.