Non-Hodgkin’s Lymphoma and HIV

Non-Hodgkin's lymphoma (NHL) is a cancer of special white blood cells called lymphocytes, which help your body fight infections. It starts in your lymph system. Because this system runs throughout your body, the cancer can show up almost anywhere. It can also spread to your liver, bones, brain, belly, and other parts of your body.

It can happen more quickly when you have a weakened immune system, so people with HIV are more likely to get it. NHL is also known as AIDS-related lymphoma, but you can get it even if you have a high CD4 count and your HIV hasn't yet become AIDS.

Antiretroviral therapy (ART) has cut the rate of non-Hodgkin's lymphoma in HIV-positive people significantly.

What Puts You at Risk?

You also have a greater chance of getting non-Hodgkin's lymphoma if you:

  • Are older, male, or white
  • Have a family history of t
  • Have been around certain pesticides

Other medical conditions that can raise your chances are:

  • Autoimmune diseases, such as rheumatoid arthritis and psoriasis
  • Epstein-Barr virus
  • A history of H. pylori infection, which causes ulcers
  • Organ transplant
  • Past treatment for Hodgkin's lymphoma

Symptoms

Non-Hodgkin's lymphoma can be easily confused with symptoms of AIDS, including:

  • Fever
  • Night sweats
  • Weight loss
  • Fatigue
  • Swelling in lymph nodes in your neck, underarms, groin, or stomach
  • Skin rash or itchy skin
  • Pain in your chest, belly, or bones

Getting a Diagnosis

Your doctor will give you a physical exam and ask you about your health habits, past illnesses, and treatments. He'll probably want you to get blood tests to check levels of different types of blood cells, enzymes, and other substances.

You'll need a biopsy to confirm non-Hodgkin's lymphoma. Your doctor will take some tissue -- part or all of a lymph node, or bone marrow from your hip or breast bone -- and look at it under a microscope.

A chest X-ray or CT scan, which takes a picture of organs and bones inside your chest, will help your doctor find out how far the cancer has spread.

Treatment

Your treatment and how successful it is depends on how advanced the cancer is (the stage), your CD4 count, and whether or not you've had other AIDS-related infections.

Continued

NHL doesn't always need to be treated right away. If your lymphoma is slow-growing or your immune system is strong, your doctor may take a wait-and-see approach, checking on you every few months to see how you're doing without treatment, unless your symptoms change or get worse.

Radiation can kill cancer cells or keep them from growing. A machine outside your body can direct high-energy waves or particles toward the cancer, or your doctor may put a radioactive substance inside your body near the cancer. Side effects such as fatigue, skin problems, and stomach upset are often short-lived, and you can usually do something about them. Long-term side effects can be more serious.

Chemotherapy stops the growth of cancer cells by killing them or preventing them from dividing. Some drugs you can take by mouth; others get injected into a vein or a muscle. These will reach your whole body. Or your doctor may be able to put the chemo directly into a specific part of your body.

Often, a combination of medicines is used. One of the most common to treat non-Hodgkin's lymphoma is called CHOP:

Chemo can have side effects, including hair loss, mouth sores, vomiting, and fatigue. You might bruise or bleed easily. And if you have HIV, you'll be at an even greater risk of infection because your white blood cell count will be lower.

Biologic or targeted therapy uses medicines based on substances your body makes to boost your immune system, helping to fight the cancer. Different kinds of drugs work in very specific ways to interrupt cancer growth. They often have less severe side effects than chemo.

Stem cell transplant starts with higher doses of chemo and sometimes radiation to kill the cancer cells. But that also kills your bone marrow, which means you can't make new blood cells. So doctors replace it with stem cells, either saved from you before treatment or from a healthy donor.

If you're diagnosed with non-Hodgkin's lymphoma, you're also more likely to get another "opportunistic infection" called Pneumocystis pneumonia, or PCP. Your doctor may suggest you take medications to help prevent it, too.

WebMD Medical Reference Reviewed by Jonathan E. Kaplan, MD on December 15, 2018

Sources

SOURCES:

New Mexico AIDS Education & Training Center: "Lymphoma."

National Cancer Institute: "General Information About AIDS-Related Lymphoma," "General Information About Non-Hodgkin's Lymphoma."

Lymphoma Canada: "HIV & Lymphoma."

American Cancer Society: "Treating Non-Hodgkin Lymphoma."

Mayo Clinic: "Non-Hodgkin's lymphoma: Treatments and drugs."

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