People who have the human immunodeficiency virus (HIV) have a much higher risk of developing cancer than the general population.

Non-Hodgkin’s lymphoma (NHL) is the most common cancer among people with HIV.

NHL is also the most common cause of death among people with HIV in developed countries, making up 23 to 30 percent of AIDS-related deaths. AIDS is the end stage of untreated HIV infection.

The development of highly active antiretroviral therapy (HAART) has decreased the risk of HIV infection becoming AIDS and has decreased the number of people with HIV who develop NHL.

Keep reading to learn more about the connection between HIV infection and NHL.

A 2019 review estimates that the lifetime risk of a person with HIV developing cancer is 25 to 40 percent. The risk of developing NHL is 11 to 17 times higher than the general population. People with HIV also tend to develop more aggressive forms of NHL.

Your immune system can often detect and destroy abnormal cells to stop cancer growth. However, HIV attacks specific white blood cells called CD4 or helper T cells. These cells help coordinate other immune cells to target infections or attack cancerous cells.

NHL is the most common cancer that develops in people with HIV infection. About 60 to 70 percent of these cancers are an aggressive form of NHL called diffuse large B cell lymphoma.

Risk factors for diffuse large B cell lymphoma include:

  • increased HIV viral loads
  • Epstein-Barr virus exposure
  • lower CD4 cell count
  • current levels of immunosuppression

Kaposi sarcoma and non-Hodgkin’s lymphoma

HIV also increases your risk of contracting human herpesvirus 8 (HHV-8).

This virus is also called Kaposi sarcoma-associated herpesvirus since it leads to the development of Kaposi sarcoma (KS). KS is a cancer that causes lesions to grow on your skin and internal organs.

In addition to KS, HHV-8 can trigger the development of lymphomas. The most common is primary effusion lymphoma (PEL), a rare and aggressive B cell lymphoma. PEL accounts for about 4 percent of all HIV-related NHL.

People with HIV tend to be diagnosed with lymphoma in advanced stages.

Signs of lymphoma are often general and can be mistaken for symptoms of AIDS-associated infections. They can include:

Treatment for HIV-associated lymphoma combines treatment of lymphoma with HIV treatment.

HAART is used to minimize damage to the immune system and may allow you to receive chemotherapy in higher doses. Taking your HAART medications as recommended is also the best way to prevent non-Hodgkin’s lymphoma from developing.

Before the development of HAART, people with HIV had a 60 to 200 times greater risk of developing NHL than the general population, but now the risk is only 11 to 17 times higher.

Treatment for NHL depends on where in the body cancer develops. Doctors use four standard treatments to treat NHL in people with HIV:

Doctors recommend the same chemotherapy regimens for people without HIV as they do for people with HIV.

Researchers are also investigating new treatment options in clinical trials.

NHL is the most common AIDS-defining cancer. AIDS-defining illnesses are potentially life threatening conditions that are signs that HIV infection has progressed to AIDS.

There are more than 60 subcategories of NHL. According to the American Cancer Society, people with HIV tend to get more aggressive forms of lymphoma than the general population.

In a 2021 study, researchers found that the following types of NHL were most common among 164 people with HIV or AIDS treated at one health center:

diffuse large B cell lymphoma56%
Burkitt lymphoma28%
plasmablastic lymphoma5%
primary diffuse large B cell lymphoma3%
mature T and natural killer cell cancers3%
other B cell lymphomas2%

The researchers also found that 3 percent of people had Hodgkin’s lymphoma.

The outlook for people with HIV and non-Hodgkin’s lymphoma depends on factors such as:

  • cancer stage
  • age
  • CD4 count
  • number of places lymphoma has spread outside your lymph system
  • whether you have a history of intravenous (IV) drug use
  • whether you can carry out daily activities

Outlook has improved greatly due to the wide use and availability of HAART. But people with HIV still have a poorer outlook than people in the general population with non-Hodgkin’s lymphoma.

A 2017 study found that the chance of dying within 3 years of an NHL diagnosis was higher for those with HIV (38 percent) compared to in the general population (22 percent).

Outcomes are very poor when lymphoma doesn’t respond to first-line chemotherapy. Currently, there’s no standard second-line therapy, but researchers continue to examine new treatment options.

HIV can affect anyone regardless of their ethnicity or sexual orientation, but some groups are at an elevated risk. African Americans make up 42 percent of new HIV infections, and 79 percent of those are male.

Fewer African Americans are virally suppressed, which increases the chances of the infection progressing to AIDS.

Here are some frequently asked questions people have about the connection between NHL and HIV.

Does having non-Hodgkin’s lymphoma increase my risk of contracting HIV?

Having lymphoma or undergoing lymphoma treatment can weaken your immune system and make you more prone to infections like HIV.

The Centers for Disease Control and Prevention (CDC) lists the odds of contracting HIV for one incidence of needle sharing as 63 in 10,000. But the odds might be significantly higher for somebody with a weakened immune system.

How can I reduce my risk of developing non-Hodgkin’s lymphoma if I have HIV?

Taking HAART as your doctor recommends lowers your risk of developing NHL and Kaposi sarcoma. Other ways you may be able to support your immune system or improve your outlook include:

  • eating an balanced diet
  • maintaining a moderate weight
  • avoiding recreational drugs and alcohol
  • attending all your regular medical checkups

What else increases my risk for non-Hodgkin’s lymphoma?

Other risk factors for the development of NHL include:

  • increasing age
  • male sex (though some subtypes are more common in females)
  • family history of NHL
  • exposure to some herbicides and insecticides
  • radiation exposure
  • other conditions that weaken your immune system

Does living with HIV increase my risk for other cancers?

HIV makes it harder for your body to fight infection. This means it also increases your risk for cancer.

In addition to NHL, HIV increases your risk of developing other virus-driven cancers, including:

It also increases risk of of developing oral or lung cancer.

Non-Hodgkin’s lymphoma is more common in people with HIV than in the general population.

Since the development of HAART, outcomes for people with HIV have improved dramatically, and fewer people now develop AIDS and AIDS-defining cancers such as NHL.

If you’re diagnosed with NHL and don’t know your HIV status, your doctor may offer you an HIV test, especially if you have an elevated risk.

Many lymphomas associated with HIV are treatable. Your doctor can help you develop a treatment plan for both HIV and NHL. They can also direct you toward support groups and other resources that may make coping with your diagnosis easier.

For more information on either condition, you can call the American Cancer Society’s 24/7 helpline at 800-227-2345 or the National Institutes of Health’s HIVinfo line at 800-448-0440.