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Ten year overall survival of children and adolescents with Hodgkin lymphoma and HIV in South Africa
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  • Jennifer Geel,
  • Katherine Eyal,
  • Marc Hendricks,
  • Khumo Myezo,
  • David Stones,
  • Fareed Omar,
  • Yasmin Goga,
  • Anel van Zyl,
  • Barry van Emmenes,
  • Manickavallie Vaithilingum,
  • Shaegan Irusen,
  • Rossella Bandini,
  • Oloko Wedi,
  • Daynia Ballot,
  • Monika Metzger,
  • Biance Rowe
Jennifer Geel
University of the Witwatersrand
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Katherine Eyal
University of Cape Town
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Marc Hendricks
Red Cross Children's Hospital
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Khumo Myezo
University of the Witwatersrand
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David Stones
University of the Free State
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Fareed Omar
Steve Biko Academic Hospital and the University of Pretoria
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Yasmin Goga
University of KwaZulu-Natal Nelson R Mandela School of Medicine
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Anel van Zyl
Stellenbosch University Faculty of Medicine and Health Sciences
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Barry van Emmenes
Frere Hospital
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Manickavallie Vaithilingum
Netcare Parklands Hospital
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Shaegan Irusen
University of the Witwatersrand Faculty of Health Sciences
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Rossella Bandini
University of the Witwatersrand Faculty of Health Sciences
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Oloko Wedi
Polokwane-Mankweng Hospital Complex
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Daynia Ballot
University of the Witwatersrand Faculty of Health Sciences
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Monika Metzger
St Jude Children's Research Hospital
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Biance Rowe
Faculty of Health Sciences, University of the Witwatersrand
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Abstract

Background and objectives: Children with Hodgkin lymphoma (HL) and Human Immunodeficiency Virus (HIV) have low 5 year overall survival rates in South Africa, home to the world’s largest HIV population. We aimed to explore factors impacting on survival in children with HIV and HL by comparing those with and without HIV, and to determine long term survival. Methods: A retrospective study was conducted to determine survival rates and prognostic factors in South African children and adolescents with HL. Univariate risk factor analysis was performed to analyse prognostic factors. Results: Between January 2000 and December 2010, 271 children and adolescents with HL were eligible for analysis. Compared to the 242 HIV-uninfected patients, the 29 HIV-infected patients were younger (median 7.2 vs 10.0 years, p=0.052) and more likely to present with Stage IV disease (p=0.000) The 5-year overall survival rate (OS) of HIV-infected patients of 49% versus 84% for HIV-uninfected patients (p=0.001) appeared to be associated with hypoalbuminaemia (<20g/dL) and a CD4 percentage of <15%. Causes of death in the HIV-infected group included disease progression (6/14), infection (4/14), unknown (3/14) and second malignancy (1/14). The 10-year OS was 45% in the HIV-infected cohort and 79% in the HIV-uninfected cohort (p=0.000). Conclusion: HIV-infected children with HL experience increased mortality due to opportunistic and nosocomial infections. Particular attention should be paid to children and adolescents with hypoalbuminaemia and low CD4 percentages at diagnosis to lower treatment-related mortality. Aggressive supportive care of children with HIV and HL may improve survival.