Rise In Lymphoma Cases Among HIV Patients A Worrying Trend - Expert

In the ward of a private hospital in the Klang Valley, a man in his 40s lies weakly on his bed. His body is frail and he looks exhausted, yet his eyes reflect hope. This man, an electrical engineer and father of two, has been diagnosed with both HIV and lymphoma.

Today, nearly three months after the diagnosis, the man – who confessed to having a history of unprotected sexual relationships years before getting married – has recovered from the life-threatening blood cancer while his HIV viral load has significantly decreased. He had chosen to undergo immunotherapy, chemotherapy and antiretroviral therapy (ART) at the hospital where he was admitted.

Examining the case, experts explained the man initially had a high HIV viral load, which weakened his immune system and made him susceptible to aggressive lymphoma cancer.

Lymphoma is a type of blood cancer that develops from the uncontrolled growth of white blood cells known as lymphocytes, eventually forming tumours. A weakened immune system in HIV patients makes them more vulnerable to this disease.

Recent studies show that HIV patients are 10 to 20 times more likely to develop lymphoma compared to individuals without HIV.

In Malaysia, recent data indicates that around 85,000 people are living with HIV, posing a potential “ticking time bomb” of lymphoma cases if not addressed seriously by the relevant authorities.

EARLY DIAGNOSIS CRUCIAL

Dr Tengku Ahmad Hidayat Tengku K Aziz, a haematologist at Beacon Hospital in Petaling Jaya, Selangor, has noticed a growing trend of lymphoma cases among HIV patients.

“Throughout 2024, I received three new cases, not including the existing cases I am currently managing,” he told Bernama.

Dr Tengku Ahmad Hidayat Tengku K Aziz

He said although the number may seem small, it reflects a trend with the potential to become more serious, especially since HIV patients in the country continue to face stigma and financial constraints, preventing them from seeking an early diagnosis.

“Early diagnosis is key to successful treatment. However, the stigma (attached to HIV) is discouraging patients from seeking medical care. And, combined with lymphoma symptoms overlapping with that of other illnesses, early detection becomes more challenging.

“Some of the symptoms of lymphoma include persistent fever, fatigue and swollen glands, which often lead patients to assume they are experiencing common health issues. As a result, without specialised tests such as a biopsy or PET scan, detecting lymphoma can be challenging,” he said.

According to Dr Tengku Ahmad Hidayat, the risk is even higher for HIV patients in rural areas due to the lack of modern diagnostic equipment in hospitals there, adding many patients may also choose to forgo testing or treatment due to concerns about its costs.

OPPORTUNISTIC INFECTIONS

He also said HIV-lymphoma patients are vulnerable to opportunistic infections (OIs) such as pneumocystis pneumonia, a type of lung infection that can cause severe shortness of breath and coughing. Tuberculosis can also attack the lungs and spread to other parts of the body.

“OIs (infections that occur more often or are more severe in people with weakened immune systems) not only weaken patients but also complicate cancer treatment. For example, chemotherapy may need to be postponed to manage serious infections.

Lymphoma cancer is also among the top 10 types of cancer detected among Malaysians.

“In my own experience, I have treated a patient who developed a brain infection due to an OI, which led to meningitis. This condition required the patient to undergo intensive care in the ICU for several weeks,” he said.

On the treatment for HIV-lymphoma, Dr Tengku Ahmad Hidayat said hospitals usually adopt a holistic approach, incorporating chemotherapy and immunotherapy, which work to destroy cancer cells but may also weaken the immune system.

Therefore, chemotherapy is administered alongside ART, which is crucial in controlling HIV viral load and strengthening the immune system.

“ART involves taking a combination of HIV medications (HIV treatment regimen) on a fixed schedule, usually once or twice a day.

“ART is recommended for everyone with HIV. While it does not completely cure HIV, it helps patients live longer, healthier lives and reduces the risk of HIV transmission,” he said, adding cancer treatment may be less effective without ART.

According to the Ministry of Health, about 66 percent of HIV patients received ART in 2021, compared to only 28 percent in 2015.

Dr Tengku Ahmad Hidayat added that advanced treatment technologies such as CAR T-cell therapy are also offered by some hospitals to treat lymphoma. However, it may not be suitable for HIV patients as HIV affects T cells.

BETTER PROGNOSIS

Meanwhile, Dr Nor Liza Ariffin, an infectious disease specialist at Thomson Hospital Kota Damansara, Selangor, said ART plays a crucial role in managing HIV patients who are also diagnosed with lymphoma.

ART works by preventing the HIV virus from replicating, thereby reducing the viral load in the body.

She explained that HIV patients often face aggressive forms of lymphoma, and in the past – before ART became easily accessible – treatment was more complicated due to low CD4 cell counts (white blood cells that play a vital role in the immune system), which made chemotherapy more challenging.

The PAL Scheme provides free second-line medication to underprivileged Malaysians living with HIV to undergo ART on helping them to prolong and improve their quality of life.

“In the past, if patients did not receive HIV treatment, they would face significant difficulties due to the side effects of chemotherapy itself. However, with free access to HIV treatment at government hospitals, managing HIV alongside lymphoma has become more controlled,” she said.

She added that the prognosis for HIV patients with lymphoma is also better when both conditions are treated either sequentially or simultaneously, with HIV treatment usually initiated first before specialists determine the right time to begin lymphoma therapy.

“Starting HIV treatment earlier helps strengthen the immune system before undergoing lymphoma treatment,” she said.

She added that societal stigma continues to deter individuals from seeking early HIV screening, adding it not only delays diagnosis but also hinders efforts to raise awareness among both doctors and patients about the possibility of lymphoma.

Highlighting the importance of psychosocial support in helping HIV patients navigate challenges, Dr Nor Liza said having a supportive family can provide emotional strength and encourage patients to adhere to their treatment regimen.

Support from non-governmental organisations such as the Malaysian AIDS Council also plays a crucial role in allowing patients to share experiences and manage emotional stress, she said, adding campaigns such as ‘HIV Testing Without Stigma’ need to be expanded to eliminate societal stigma against those affected.

“Through early diagnosis, accurate treatment and comprehensive support, the hope for recovery can become a reality,” she said.