Non-Hodgkin Lymphoma in Adults Living with HIV in Botswana: Morphology and Immunophenotypes
Keywords:
Non-Hodgkin lymphoma, Adult, HIV/AIDS, Botswana, Morphology, ImmunophenotypeAbstract
Background and Objective: The onset of the Human Immunodeficiency Virus/Acquired Immunodeficiency syndrome (HIV/AIDS) pandemic was marked by a rapid increase in aggressive non-Hodgkin lymphomas (NHLs). Botswana has made tremendous efforts in HIV control having surpassed the UNAIDS 90:90:90 target. In addition, commendable efforts have been made towards the elimination of mother-to-child transmission of HIV (eMTCT). There is limited data on immunophenotypes of non-Hodgkin lymphoma (NHL) in Botswana, it is therefore against this background that we sought to bridge that knowledge gap in Botswana. To determine the clinical, morphological and immunophenotypes of non-Hodgkin lymphoma in adults living with HIV (ALWH) in Botswana.
Methods: Archived pathology slides and reports of 131 ALWH who had a diagnosis of non-Hodgkin lymphoma were retrieved from the repository. Descriptive statistics were used to summarize the clinicopathological data: age, sex, HIV status, anatomical site of disease, histopathology and immunophenotype results. SPSS version 27.0 software package was used for data analysis. Fisher’s exact test with a p-value of 0.05 was used to determine the significance of the findings.
Results: The majority of ALWH were male 78 (59.5%) while females were 53 (40.5%). The maximum incidence of NHL in both sexes was in the 41-60 years age group at 75/131 patients (57.3%). Most NHLs were of B-cell origin and accounted for 121 (92.4%), of which diffuse large B-cell lymphoma (DLBCL) was the most common subtype at 76 (58.0%) followed by Plasmablastic lymphoma (PBL) 32 (24.4%). T-cell lymphoma accounted for 10 (7.6%) in total with peripheral T-cell lymphoma not otherwise specified (PTCL/NOS) the most common. There was no statistically significant association between gender and NHL subtypes which were identified in the study including DLBCL and PBL (two-tailed, p=0.158).
Conclusion: DLBCL and PBL were the most common subtypes of NHL in ALWH in Botswana. Notably, the subtype distribution of NHL has not changed despite widespread anti-retroviral therapy (ART) use. This data further strengthens the existing knowledge on the distribution of NHL subtypes in ALWH in Botswana.
Downloads
References
Polepole P, Mudenda VC, Munsaka SM, Zhang LW. Spectrum of common Hodgkin lymphoma and non-Hodgkin lymphomas subtypes in Zambia: a 3-year records review. Journal of Health, Population, and Nutrition. 2021, 40(1), 37. DOI: 10.1186/s41043-021-00261-y
UNAIDS. Country factsheet: Botswana. 2022. https://www.unaids.org/en/regionscountries/countries/botswana
Naresh KN, Raphael M, Ayers L, Hurwitz N, Calbi V, Rogena E, et al. Lymphomas in sub-Saharan Africa--what can we learn and how can we help in improving diagnosis, managing patients and fostering translational research? British Journal of Haematology. 2011, 154(6), 696-703. DOI: 10.1111/j.1365-2141.2011.08772.x
Iyer HS, Kohler RE, Ramogola-Masire D, Brown C, Molebatsi K, Grover S, et al. Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study. PLoS One. 2019, 14(6), e0218094. DOI: 10.1371/journal.pone.0218094
Perry AM, Perner Y, Diebold J, Nathwani BN, MacLennan KA, Müller-Hermelink HK, et al. Non-hodgkin lymphoma in Southern Africa: review of 487 cases from The International Non-Hodgkin Lymphoma Classification Project. British Journal of Hematology. 2015, 172(5), 716-723. DOI: 10.1111/bjh.13885
Piccaluga PP, Cascianelli C, Beruzzi C, Ascani S, Fraternali-Orcioni G, Lazzi S, et al. Epidemiology of malignant lymphomas in Italy. Open Access Journal Oncology Medicine. 2021, 5(2), OAJOM.MS.ID.000209. DOI: 10.32474/OAJOM.2021.05.000209
Dryden-Peterson S, Medhin H, Kebabonye-Pusoentsi M, Seage GR 3rd, Suneja G, Kayembe MK, et al. Cancer incidence following expansion of HIV treatment in Botswana. PLoS One, 10(8), e0135602. DOI: 10.1371/journal.pone.0135602
Milligan MG, Bigger E, Abramson JS, Sohani AR, Zola M, Kayembe MKA, et al. Impact of HIV infection on the clinical presentation and survival of non-hodgkin lymphoma: a prospective observational study from Botswana. Journal of Global Oncology. 2018, 4, 1-11. DOI: 10.1200/jgo.17.00084
Wiggill TM, Mantina H, Willem P, Perner Y, Stevens WS. Changing pattern of lymphoma subgroups at a tertiary academic complex in a high-prevalence HIV setting: a South African perspective. Journal of Acquired Immune Deficiency Syndromes. 2011, 56(5), 460-466. DOI: 10.1097/QAI.0b013e31820bb06a
Hämmerl L, Colombet M, Rochford R, Ogwang DM, Parkin DM. The burden of Burkitt lymphoma in Africa. Infectious Agents and Cancer. 2019, 14(1), 17. DOI: 10.1186/s13027-019-0236-7
Eyawo O, Franco-Villalobos C, Hull MW, Nohpal A, Samji H, Sereda P, et al. Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infectious Diseases. 2017, 17(1), 174. DOI: 10.1186/s12879-017-2254-7
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021, 71(3), 209-249. DOI: 10.3322/caac.21660
Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IBO, Berti E, et al. The 5th edition of the World Health Organization Classification of haematolymphoid tumours: lymphoid neoplasms. Leukemia. 2022, 36(7), 1720-1748. DOI: 10.1038/s41375-022-01620-2
Farahani M, Vable A, Lebelonyane R, Seipone K, Anderson M, Avalos A, et al. Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis. The Lancet. Global Health. 2014, 2(1), e44-e50. DOI: 10.1016/S2214-109X(13)70149-9
Lisa M, Verma PK, Shuchismita 1, Nishi 1, Mustaqueem SF. Distribution of lymphoma subtypes in Bihar-analysis of 518 cases using the WHO classification of lymphoid tumors (2017). Journal of Laboratory Physicians. 2020, 12(2), 103-110. DOI: 10.1055/s-0040-1716633
Uzoma IC, Taiwo IA, Granai M, Di Stefano G, Sorrentino E, Mannucci S, et al. Distinct pattern of lymphoid neoplasms characterizations according to the WHO classification (2016) and prevalence of associated Epstein–Barr virus infection in Nigeria population. Infectious Agents and Cancer. 2021, 16(1), 36. DOI: 10.1186/s13027-021-00378-z
Gogia A, Das CK, Kumar L, Sharma A, Sharma MC, Mallick S. Profile of non-Hodgkin lymphoma: An Indian perspective. South Asian Journal of Cancer. 2018, 7(3), 162. DOI: 10.4103/sajc.sajc_60_18
Cáceres A, Jene A, Esko T, Pérez-Jurado LA, González JR. Extreme downregulation of chromosome y and cancer risk in men. Journal of the National Cancer Institute. 2020, 112(9), 913-920. DOI: 10.1093/jnci/djz232
Padhi S, Paul TR, Challa S, Prayaga AK, Rajappa S, Raghunadharao D, et al. Primary extra nodal non Hodgkin lymphoma: a 5 year retrospective analysis. Asian Pacific Journal of Cancer Prevention. 2012, 13(10), 4889-4895. DOI: 10.7314/apjcp.2012.13.10.4889
Tomoka T, Montgomery ND, Powers E, Dhungel BM, Morgan EA, Mulenga M, et al. Lymphoma and pathology in Sub-Saharan Africa: current approaches and future directions. Clinics in Laboratory Medicine. 2018, 38(1), 91-100. DOI: 10.1016/j.cll.2017.10.007
Ambrosio MR, Mundo L, Gazaneo S, Picciolini M, Vara PS, Sayed S, et al. MicroRNAs sequencing unveils distinct molecular subgroups of plasmablastic lymphoma. Oncotarget. 2017, 8(64), 107356-107373. DOI: 10.18632/oncotarget.22219
Magangane PS, Mohamed Z, Naidoo R. Diffuse large B-cell lymphoma in a high human immunodeficiency virus (HIV) prevalence, low-resource setting. South African Journal of Oncology. 2020, 4(1), a104. DOI: 10.4102/sajo.v4i0.104
Berhan A, Bayleyegn B, Getaneh Z. HIV/AIDS associated lymphoma: review. Blood and Lymphatic Cancer: Targets and Therapy. 2022, 12, 31-45. DOI: 10.2147/BLCTT.S361320
Rodriguez O, Sowash M, Mosojane KI, Ralefala T, Grover S, Haun P, et al. A retrospective review of cutaneous lymphoma in Botswana. International Journal of Dermatology. 2020, 59(3), 352-358. DOI: 10.1111/ijd.14690
Mantina H, Wiggill TM, Carmona S, Perner Y, Stevens WS. Characterization of lymphomas in a high prevalence HIV setting. Journal of Acquired Immune Deficiency Syndromes. 2010, 53(5), 656-660. DOI: 10.1097/QAI.0b013e3181bf5544
Hübel K. The changing landscape of lymphoma associated with HIV infection. Current Oncology Reports. 2020, 22(11), 111. DOI: 10.1007/s11912-020-00973-0
Fitzpatrick MJ, Sayed S, Moloo Z, Kayembe MKA, Roberts DJ, Pham TA, et al. Clinicopathologic features of peripheral T-cell lymphoma in Sub-Saharan Africa. American Journal of Clinical Pathology. 2021, 156(1), 42-55. DOI: DOI: 10.1093/AJCP/AQAA201
Gondwe Y, Kudowa E, Tomoka T, Kasonkanji ED, Kaimila B, Zuze T, et al. Comparison of baseline lymphoma and HIV characteristics in Malawi before and after implementation of universal antiretroviral therapy. PloS One. 2022, 17(9), e0273408. DOI: 10.1371/journal.pone.0273408
Roy A, Kar R, Basu D, Badhe BA. Spectrum of histopathologic diagnosis of lymph node biopsies: a descriptive study from a tertiary care center in South India over 5½ years. Indian Journal of Pathology & Microbiology. 2013, 56(2), 103-108. DOI: 10.4103/0377-4929.118692
Sharma M, Mannan R, Madhukar M, Navani S, Manjari M, Bhasin TS, et al. Immunohistochemical (IHC) Analysis of Non-Hodgkin's Lymphoma (NHL) spectrum according to WHO/REAL classification: a single centre experience from Punjab, India. Journal of Clinical and Diagnostic Research. 2014, 8(1), 46-49. DOI: 10.7860/JCDR/2014/8173.3988
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Gaone Abigail Moalosi , Lynnette Tumwine Kyokunda , Moses Rugemalila, Blessing Zambuko , Pier Paolo Piccaluga
This work is licensed under a Creative Commons Attribution 4.0 International License.
