Clinical Characteristics Of Incident Lymphoma In Malawi Before And After Implementation Of Universal Art

Abstract Purpose: In 2016, Malawi expanded eligibility for antiretroviral therapy (ART) to anyone with confirmed HIV infection. Here, we assess the impact on lymphoma presentation. Methods: We enrolled patients with newly diagnosed lymphoproliferative disorders 2013-2020. We categorized patients pre-universal ART (pre-UART) (2013-June 2016) or post-universal ART (post-UART) (July 2016-2020) and evaluated clinical characteristics. Results: There were 157 cases pre-UART and 256 post-UART. The most common diagnoses were diffuse large B-cell lymphoma (DLBCL) (43%), low-grade lymphoma (12%), Burkitt lymphoma (10%), Hodgkin lymphoma (9%), and multicentric Castleman disease (7%). HIV prevalence was 50%, mean age 43, and 62% male. 66% of pre-UART HIV+ knew their HIV status, for median 5 years (IQR 2-8), and 53% were on ART for median 4 years (IQR 2-7). 80% of post-UART HIV+ knew their HIV status (p=0.02), for median 4 years (IQR 2-9) and 70% were on ART for median 4 years (IQR 2-8). HIV was suppressed <1000 copies/mL in 56% (n=33/59) pre-UART and 71% (n=73/103) post-UART (p=0.05). Among DLBCL, 61% (n=23/38) of pre-UART HIV+ knew their HIV status, for median 5 years (IQR 2-9), and 46% were on ART for median 4 years (IQR 2-6). 82% (n=51/62) of post-UART DLBCL HIV+ knew their HIV status (p=0.02), for median 5 years (IQR 2-9) and 68% were on ART for median 5 years (IQR 2-9). Post-UART DLBCL patients had median HIV viral load of 0 log copies/mL (IQR 0-10) compared to pre-UART (6.2 log copies/mL, IQR 0-10) (p=0.09). CD4 count, age adjusted-IPI and Ki67 proliferation index were similar between DLBCL in the two groups. Conclusion: There were no significant differences in lymphoma subtypes diagnosed or in traditional DLBCL prognostic factors after implementation of universal ART in Malawi. However, HIV was better controlled in the post-UART period and differences in immunological status may have implications for therapy and prognosis. Citation Format: Yolanda Gondwe, Evaristar Kudowa, Matthew Painschab, Tamiwe Tomoka, Yuri Fedoriw, Edwards Kasonkanji, Bongani Kaimila, Takondwa Zuze, Victor Mithi, Noel Mumba, Stephen Kimani, Maurice Mulenga. Clinical Characteristics of Incident Lymphoma in Malawi before and after Implementation of Universal ART [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 88.