Clinicopathological Features and Prognostic Factors of AIDS-Related Lymphoma: A Retrospective Single- Center Study

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 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 > 1, elevated lactate dehydrogenase (LDH), advanced stage, and multiple extranodal involvements (all P  < 0.05). Multivariate analysis revealed CD4 + T cell count < 200 cells/µL (HR: 2.051, P  = 0.029) and elevated LDH (HR: 0.383, P  = 0.005) as independent prognostic factors. In conclusion, NHL, particularly BL and DLBCL, are prevalent in PLWH. Severe immunodeficiency and elevated LDH levels are key factors contributing to mortality in AIDS-related NHL.