Non-Hodgkin Lymphoma in Adults Living with HIV in Botswana: Morphology and Immunophenotypes

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.