P-GemOxD with lopinavir/ritonavir ART yields complete metabolic response in HIV-associated ENKTCLTreatment plan shows success for rare lymphoma in HIV patient

Extranodal NK/T-cell lymphoma (ENKTCL) is a rare aggressive lymphoma whose management is complicated by HIV-1 co-infection due to drug-drug interactions and overlapping toxicities, specifically the convergent hepatorenal and hematological toxicities resulting from the concurrent use of chemotherapeutic regimens and ART. We report a middle-aged HIV-1 positive man (CD4+ T cells:198/μL, HIV-1 RNA:9.70×10³ copies/mL) with stage IE ENKTCL nasal type, whose initial nasal congestion was repeatedly misdiagnosed as sinusitis. An integrase strand transfer inhibitor-based (INSTIs) ART was unaffordable, and efavirenz was contraindicated by prior allergy, necessitating continuation of lopinavir/ritonavir-based ART despite its CYP3A4 inhibition. A multidisciplinary team guided concurrent therapy with two full-dose cycles of P-GemOxD (gemcitabine, pegaspargase, oxaliplatin, dexamethasone) followed by consolidative radiotherapy (20 fractions). The patient tolerated treatment without grade ≥ 3 adverse events. Post-therapy PET-CT confirmed complete metabolic response, with HIV-1 RNA undetectable. At 9-month follow-up, remission persisted and CD4+ T cells rose to 255/μL. This case illustrates that an MDT model offers a practical management framework for delivering full-dose P-GemOxD chemotherapy with non-INSTIs when INSTI-based regimens are not accessible. Our experience provides a reference strategy for managing the therapeutic complexities of concurrent HIV and malignancy.