HIV infection and survival in Hodgkin lymphoma: a real-world analysis of a multicenter research network

Abstract

Despite effective antiretroviral therapy, people living with human immunodeficiency virus (HIV) (PLWH) remain at a higher risk of developing Hodgkin lymphoma (HL). Further, survival disparities persist despite similar treatment recommendations. Herein, we present a global retrospective cohort study including data of adult (≥18 years) diagnosed with HL between 2015 and 2025 from the TriNetX database to evaluate the survival outcomes of Hodgkin lymphoma in HIV-infected versus non-HIV-infected patients and analyze the associated risk factors. Patients were stratified according to HIV status and matched 1:1 for age, sex, race, and comorbidities. Overall survival (OS) was analyzed using Kaplan–Meier and Cox proportional hazards models. A total of 927 matched HIV-infected and non-HIV-infected patients were included. Overall, HIV-positive status was associated with significantly inferior OS (HR 1.42; 95% CI 1.10–1.84; p = 0.033). Among PLWH, cerebrovascular disease, hepatitis C virus infection, and chronic kidney disease independently predicted increased mortality. In a matched subgroup of patients treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy (n = 154 per group), OS did not differ significantly between HIV-positive and HIV-negative groups (HR 1.37; 95% CI 0.73–2.56; p = 0.247). In conclusion, HIV-infected patients with HL experienced worse OS compared with non-HIV-infected individuals, but the outcomes were comparable when treated with ABVD chemotherapy, highlighting the importance of optimal treatment delivery and comorbidity management in PLWH.