Could Active TB be a Major Contributor to the Disparity in Presentation and Mortality for cHL in HIV + and HIV - Individuals in South Africa?

Classical Hodgkin lymphoma (cHL) outcomes in people living with HIV (PLWH) in South Africa are substantially worse than those in HIV-negative patients. Prior and current tuberculosis (TB) infection are common amongst PLWH and cHL in South Africa. We set out to evaluate the effect of active TB disease on presenting characteristics and outcomes in newly diagnosed cHL patients receiving care in Johannesburg, South Africa. With approvals from the Human Research Ethics Committee of the University of the Witwatersrand and the Johns Hopkins Institutional Review Boards, we conducted a prospective, observational study of newly diagnosed patients with cHL ≥18 years at Chris Hani Baragwanath Academic and Netcare Olivedale Hospitals in Johannesburg, South Africa between March 2021 and April 2023. Participants' data include history, abstracted HIV status, CD4 count, HIV viral load at the time of cHL diagnosis, baseline laboratory data, staging work-up, and review of diagnostic pathology. TB diagnosis was based on routine clinical procedures. Pre-treatment whole blood was collected in cell stabilizing tubes and processed locally using a plasma cell-free DNA (cfDNA) protocol. cfDNA was then isolated in the USA with subsequent analysis of fragment length, cfDNA and gDNA concentrations, and EBV copy number. Among 43 patients, 28 (65%) were PLWH. Fifty-one percent were female, mean age was 41 years and 98% of patients were diagnosed with advanced stage disease and B-symptoms. Forty-seven percent had marrow involvement including 18/28 (64%) PLWH. Among PLWH, mean CD4 count was 180 and 61% of patients had viral load