Hodgkin and non‐Hodgkin lymphomas in the post‐antiretroviral therapy era according to HIV virological suppression

Abstract Objectives Lymphomas remain among the most frequent HIV‐associated malignancies, with risk persisting despite effective virological control. This study describes the clinical, epidemiological and prognostic characteristics of lymphomas (both Hodgkin HL and non‐Hodgkin NHL) in people living with HIV (PLWH), according to virological suppression at diagnosis and assesses lymphoma‐related mortality at 1 year and overall survival at 5 years. Methods We conducted a multicentre retrospective study including PLWH from the Spanish CoRIS cohort, who were diagnosed with lymphoma between 2004 and 2022 and had HIV viral load data at diagnosis. Virological suppression was defined as HIV‐1 RNA <100 copies/mL within the 6 months prior to and 1 month following lymphoma diagnosis. Results Among 18 573 PLWH included in CoRIS, 291 developed lymphoma, with virological data available for 245 individuals, of whom 49 (20%) had virological suppression. People with detectable HIV viral load had lower CD4 counts (median 180 cells/mm 3 IQR 80–330 vs. 371 cells/mm 3 IQR 202–583, p < 0.001) and more advanced Ann Arbor stage (stage III–IV: 82.0% vs. 64.1%, p = 0.027) compared with those with virological suppression. Despite this, they showed similar treatment response (complete remission: 67.1% vs. 76.2%) and relapse rates (16.3% vs. 18.4%, p = 0.779). Furthermore, virological suppression was not independently associated with 1‐year lymphoma‐specific or 5‐year overall survival. Conclusions In PLWH diagnosed with lymphoma, prognosis is independent of HIV virological status at diagnosis. These findings support that lymphoma management in PLWH should be guided by standard oncological criteria, alongside antiretroviral therapy, regardless of HIV viral suppression status.