Lymphoma and HIV

Lymphoma is a cancer of the lymphatic system. The lymphatic system is part of the body's immune system.

There are two main sub-types of lymphoma:

• non-Hodgkin lymphoma (NHL)
• Hodgkin lymphoma.

HIV is a virus that attacks the immune system. Your immune system helps protect you from infection and disease. If your immune system is damaged by HIV, you are more likely to catch infections and to develop illnesses such as lymphoma.

People with HIV do not always develop lymphoma. But if you have HIV, you have a higher risk of some types of lymphoma. This includes Hodgkin lymphoma and some types of NHL.

The main types of NHL that affect people with HIV are:

• diffuse large B-cell lymphoma (DLBCL)
• Burkitt lymphoma (BL)
• primary central nervous system lymphoma (PCNSL).

These types of lymphoma also affect people without HIV.

Your lymphoma doctors and HIV doctors will work together to plan your treatment. This may mean you have to travel to a hospital that treats both HIV and lymphoma.

Your lymphoma doctor will explain your treatment plan and you will make a decision together about treatment. They can also talk to you about possible ways to preserve your fertility.

Different types of lymphoma are treated in slightly different ways, but the main treatment is usually chemotherapy with steroids. For some types of lymphoma, you will also have a type of targeted therapy drug. Some people will have radiotherapy to treat an area of lymphoma.

If there are no signs of lymphoma after treatment, this is called remission. If lymphoma comes back, this is called recurrence or relapse.

People with HIV usually have the same lymphoma treatment as people who do not have HIV. But there can be a higher risk of some side effects. To reduce this risk and make lymphoma treatment as effective as possible, you will have treatment

• to control the HIV
• to prevent infections.

There is no cure for HIV, but anti-retroviral drugs help keep HIV under control. You take these drugs as tablets every day for the rest of your life. They may also be called combination therapy or HAART.

If you are not taking anti-retroviral drugs already, your doctor will talk to you about starting them. If the HIV is treated with these drugs, lymphoma treatment is more effective and you are less likely to have side effects.

Sometimes your HIV doctor will change your anti-retroviral drugs. This is because some of them can react with cancer treatments.

Some lymphoma treatments affect the immune system and increase your risk of infections. You may have treatment to prevent infections, such as:

• antibiotics
• anti-viral medicines
• anti-fungal medicines.
• Treatment to prevent infections is called prophylaxis.

You may also have a drug called G-CSF. You have it as a small injection under the skin. GCSF encourages your body to make more white blood cells. This helps increase the number of infection-fighting cells in your blood.

Steroids are drugs that are often given with chemotherapy to treat lymphoma. They help make chemotherapy more effective. They also help you feel better and can make you feel less sick.

Targeted therapies recognise and target specific proteins on the lymphoma cells. They also encourage the body’s immune system to attack and destroy the lymphoma cells.

The main type of targeted therapy used to treat lymphoma is a drug called rituximab.

You may have rituximab with chemotherapy and steroids. Sometimes it is given alone as the main treatment for lymphoma.

You may be more likely to get infections while you are having rituximab. You will have regular blood tests and check-ups throughout your treatment.

If you have any signs of infection during treatment, it is very important to contact the hospital for advice immediately.

Radiotherapy uses high-energy rays to destroy cancer cells while doing as little harm as possible to normal cells. It only treats the area of the body that the radiotherapy is aimed at.

Radiotherapy is sometimes used to treat groups of lymph nodes that are affected by lymphoma.