Clinicopathological features and prognostic factors of AIDS-related lymphoma: a retrospective single-center study in China

AIDS-related lymphoma (ARL) is a leading cause of mortality among people living with HIV (PLWH), characterized by distinct clinicopathological features and a generally poor prognosis. However, comprehensive studies on ARL remain limited. This study aimed to evaluate the clinicopathological characteristics, immune status, and Epstein-Barr virus (EBV)/HIV viral loads in PLWH diagnosed with lymphoma, and to assess their prognostic significance. A retrospective analysis was conducted on 130 ARL cases diagnosed between 2017 and 2024. The cohort included 56 Burkitt lymphoma (BL), 51 diffuse large B-cell lymphoma (DLBCL), 9 Hodgkin lymphoma (HL), 8 plasmablastic lymphoma (PBL), and 6 T/NK cell lymphoma patients. The median age was 39 years, with 94.6% of patients being male. The 2-year overall survival (OS) rate was 50.6%, with HL showing the highest survival rate (85.7%) and BL the lowest (43.8%). Univariate analysis identified several factors significantly associated with poorer OS in non-Hodgkin lymphoma (NHL), including CD4 + T cell count < 200 cells/µL, presence of B symptoms, Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2, elevated lactate dehydrogenase (LDH), Ann Arbor Stage III/IV disease, > 1 site with extranodal involvement, and bone marrow involvement (all P < 0.05). Multivariate analysis revealed that CD4 + T cell count < 200 cells/µL (HR: 2.085, P = 0.026) and elevated LDH (HR: 0.378, P = 0.005) were independent prognostic factors. In conclusion, NHL, particularly BL and DLBCL, is the predominant lymphoma subtype among PLWH. Severe immunodeficiency and elevated LDH may serve as effective prognostic factors for predicting OS in patients with AIDS-related NHL.