Lymphoma and HIV

Lymphoma is a cancer of the lymphatic system, which is part of the immune system. HIV is a virus that attacks the immune system. People with HIV are more at risk of developing lymphoma because their immune system is damaged. This includes Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL). Your doctor will explain which type you have.

Your cancer doctors and HIV doctors will work together. You may have to travel to a specialist hospital that treats both people with HIV and people with cancer. We have information about getting help with travel to and from hospital.

The main treatments for lymphoma are chemotherapy and steroids. You may also have a type of drug called a monoclonal antibody. Some people have radiotherapy to treat an area of lymphoma. A stem cell transplant is sometimes used to treat lymphoma, but many people do not need this.

Having HIV won’t usually affect the way the lymphoma is treated. But you may have a higher risk of some side effects. To reduce this risk and make lymphoma treatment as effective as possible, you will have treatment:

  • to control the HIV
  • to prevent infections.

Understanding lymphoma and HIV

It is best to read this information with our general information about lymphoma. If you have any more questions, you can ask your doctor or nurse at the hospital where you are having treatment.

Lymphoma is a cancer of the lymphatic system, which is part of the body’s immune system. There are two main sub-types of lymphoma:

HIV is a virus that attacks the immune system. Your immune system helps protect you from infection and disease. If your immune system is damaged by HIV, you are more likely to catch infections and to develop illnesses such as lymphoma.

There is no cure for HIV, but drugs called anti-retrovirals can keep it under control. You take these drugs as tablets every day for life. They may also be called combination therapy or HAART. Your doctor will take regular blood tests to monitor the HIV and check how well treatment is working.

People with HIV don’t always develop lymphoma. But if you have HIV, you have a higher risk of some types of lymphoma. This includes HL and some types of NHL called:

All these types of lymphoma also affect people without HIV.


Diagnosing lymphoma and HIV

If you are having tests to diagnose HL or NHL, your doctor will usually ask you if they can take a blood sample to check for HIV too. When they know whether you have HIV, they can plan safer and more effective treatment for you.

For some people, this means they find out they have HIV and lymphoma at the same time. This can be a lot to take in. You will be given information about both conditions and how they are treated. You may be asked to make decisions about having treatments. You will meet some doctors and nurses who specialise in lymphoma, and others who specialise in HIV infection.


Treating lymphoma and HIV

Treatment for lymphoma may depend on:

  • the type of lymphoma
  • what areas of your body are affected
  • whether you have symptoms caused by lymphoma
  • your age and general health
  • the results of your blood tests.

If you have HIV, your lymphoma doctors and HIV doctors will work together to plan your treatment. This may mean you have to travel to a hospital that treats both people with HIV and people with lymphoma. We have more information about getting help with travel to and from hospital.

Your lymphoma doctor will explain your treatment plan and you will make a decision together about treatment. Different types of lymphoma are treated in slightly different ways, but the main treatment is usually chemotherapy with steroids. For some types of lymphoma, you will also have a type of drug called a monoclonal antibody. Some people will have radiotherapy to treat an area of lymphoma.

If there are no signs of lymphoma after treatment, this is called remission. If lymphoma comes back, this is called recurrence or relapse.

People with HIV can usually have the same lymphoma treatment as people who do not have HIV. But there can be a higher risk of some side effects. To reduce this risk and make lymphoma treatment as effective as possible, you will have treatment:

  • to control the HIV
  • to prevent infections.

Anti-retroviral drugs

If you are not taking anti-retroviral drugs already, your doctor will talk to you about starting them. If the HIV is treated with these drugs, lymphoma treatment:

  • is more effective
  • has less risk of side effects.

Sometimes your HIV doctor will change your anti-retroviral drugs, as some of them can react with chemotherapy.

Treatment to prevent infections

Some lymphoma treatments affect the immune system and increase your risk of infections. You may be given treatment to prevent infections, such as:

  • antibiotics
  • anti-viral medicines
  • anti-fungal medicines.

You may also be given injections called G-CSF. These injections stimulate your body to make new white blood cells. This helps increase the number of infection-fighting cells in your blood.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

Most people have chemotherapy for lymphoma as an outpatient. Usually you have a combination of 2 or more chemotherapy drugs. The drugs are usually given as liquids into a vein (intravenously), or as tablets.

With some types of lymphoma, there is a higher risk the lymphoma will spread to the brain. You may be given chemotherapy into the spinal fluid to reduce this risk. This is called intrathecal chemotherapy. This can also be used to treat lymphoma that is already affecting the brain.

You usually have your chemotherapy drugs over one or a few days. Then you have a break of a few weeks without chemotherapy. The treatment and break is called one cycle of treatment. The break allows your body to recover from any side effects before you start the next cycle.

Your whole course of chemotherapy treatment may last several months. During this time, you have regular check-ups at the hospital.

Side effects of chemotherapy

Different chemotherapy drugs have different side effects. Your lymphoma doctor or nurse can tell you what to expect. You should always tell them about any side effects you have and any new symptoms you develop. They can give you medicines to prevent or reduce them if needed.

Chemotherapy may affect how well your immune system is working for a time. This is a common side effect. It happens because the chemotherapy reduces the number of infection-fighting white blood cells in your blood.

If you are taking anti-retroviral drugs, this should not affect how well the HIV infection is controlled. But it can make you more likely to catch other infections. You will have regular blood tests and check-ups throughout your chemotherapy. You will be given contact details for your hospital before you start treatment. If you have any signs of infection during chemotherapy, it is very important to contact the hospital for advice immediately.

Sometimes, your doctor will change your dose of chemotherapy or the drugs you are given. This is only likely if there is a risk of serious side effects.

Steroids

Steroids are drugs that are often given with chemotherapy to treat lymphomas. They help make chemotherapy more effective. They also help you feel better and can make you feel less sick.

Targeted therapy

Targeted therapies (also called biological therapies) are drugs that use unique features of the cancer to find and treat cancer cells. These drugs only ‘target’ the cancer cells, so they have less effect on healthy cells.

The main type of targeted therapy used to treat lymphoma is a monoclonal antibody called rituximab. This is given as a liquid into a vein (intravenously), or as an injection under the skin (subcutaneously).

You may be given rituximab with chemotherapy and steroids. Sometimes it is given alone as the main treatment for lymphoma.

Like with chemotherapy, you may be more likely to catch infections while you are having rituximab. You will have regular blood tests and check-ups throughout your treatment. If you have any signs of infection during treatment, it is very important to contact the hospital for advice immediately.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to nearby healthy cells. Radiotherapy only treats the area of the body that the rays are aimed at.

This treatment may be used to treat an area of lymphoma in the body. This can treat any remaining lymphoma cells in the area. It can also reduce the risk of lymphoma coming back in the area. Radiotherapy is also sometimes given to treat symptoms such as pain.

Stem cell treatment (transplants)

This treatment is sometimes used to treat lymphoma, but many people do not need it. It is an intensive treatment, so it is not suitable for everyone.

Stem cells are a type of blood cell that can make all other types of blood cells. There are two different types of stem cell treatment:

High-dose treatment with stem cell support (autologous stem cell transplant)

Some people have treatment to put the lymphoma into remission. Then some of their own stem cells are collected from their blood and stored. Then they have high doses of chemotherapy to try to destroy any remaining lymphoma cells. After this, their stem cells are returned through a drip (like a blood transfusion). The stem cells help their blood cells recover from the effects of chemotherapy.

Donor transplant (allogeneic transplant)

Some people have chemotherapy to put the lymphoma into remission and are then given stem cells from another person (a donor).


Getting support

Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse. You can also call our cancer support specialists free on 0808 808 00 00. The organisations below also offer information and support:

  • Bloodwise offers support and information to people affected by blood cancers, including lymphoma.
  • The Lymphoma Association gives emotional support, advice and information on all aspects of Hodgkin lymphoma and non-Hodgkin lymphoma. It has a national network of people with lymphoma, and local groups.
  • NAM Aidsmap provides information for people living and working with HIV and AIDS.
  • The National Sexual Health Helpline provides free information, advice and counselling on all aspects of HIV, AIDS and sexual health. You can contact it on 0300 123 7123.
  • Positively UK offers peer support services, including support groups for men and women, support groups for African people, counselling, a children and family service, and a helpline for people living with HIV.
  • Terrence Higgins Trust offers advice and information on all aspects of HIV and AIDS, including counselling and support, health promotion and benefits advice.

Back to Understanding Hodgkin lymphoma

What is cancer?

There are more than 200 different kinds of cancer, each with its own name and treatment.