# Challenges in the Treatment of HIV-Related Lymphomas Complicated by COVID-19: Case Study and Review of the Literature

## TL;DR

This paper discusses the challenges of treating HIV-related lymphomas complicated by COVID-19, based on a case study and literature review.

## Contribution

The paper presents a new case of AIDS-related lymphoma complicated by prolonged SARS-CoV-2 infection and reviews existing literature on this rare condition.

## Key findings

- Only five cases of AIDS-related lymphoma and COVID-19 have been reported, with most patients having mild SARS-CoV-2 infections.
- A 49-year-old patient with AIDS-related lymphoma had a prolonged SARS-CoV-2 infection that interfered with cancer treatment and led to death.
- Prolonged SARS-CoV-2 infection and opportunistic infections hinder effective chemotherapy delivery in these patients.

## Abstract

Lymphomas remain a significant cause of morbidity and mortality among patients living with HIV. Although the introduction of antiretroviral therapy has led to a reduction in the incidence of AIDS-related lymphomas (ARL) and an overall improvement in prognosis, these malignancies continue to pose a considerable clinical challenge. Beyond the inherent complexity of lymphoma treatment itself, the management of comorbidities, particularly infections, represents a therapeutic obstacle. Here, we review the published evidence on ARL complicated by COVID-19. Despite the fact that nearly 800 million confirmed cases of SARS-CoV-2 infection have been reported so far, only five cases of ARL and COVID-19 have been published, among whom most patients experienced a mild course of SARS-CoV-2 infection, with only one case progressing to severe COVID-19 that required oxygen therapy and prolonged hospitalization. Additionally, we present another case of a 49-year-old male patient with newly diagnosed ARL, Epstein–Barr virus (EBV)-positive, diffuse large B-cell lymphoma, not otherwise specified, complicated by prolonged SARS-CoV-2 infection. Although initially asymptomatic, the patient subsequently experienced transient respiratory failure. Despite administration of molnupiravir, both SARS-CoV-2 antigen and RT-qPCR tests remained positive for a minimum of 113 days. The prolonged SARS-CoV-2 infection, in conjunction with other opportunistic infections, impeded the delivery of adequate chemotherapy dose intensity and contributed to disease progression and ultimately the patient’s death. This case and review of the literature underscores the diversity of the clinical course of SARS-CoV-2 infection in patients with ARL and highlights the associated challenges in delivering optimal anti-lymphoma therapy in those patients.