The Head of the KwaZulu-Natal (KZN) Academic Complex Haematology Department, Dr Nadine Rapiti, is the first researcher to highlight missing data on HIV-associated lymphomas (HAL) in the province, which is the epicentre of HIV in South Africa and globally.
Supervised by the Head of UKZN’s Infectious Diseases Department, Professor Yunus Moosa, her study was titled: Profile and Management of HIV Associated Lymphoma.
Until recently, there was limited research on HAL in the province. Lymphomas are cancers that start in the lymphatic system – the tissues and organs that produce, store, and carry white blood cells that fight infection. They are of greater concern for people living with HIV as this means accelerated disease progression.
‘Worldwide, HIV-associated lymphoma is a common HIV-related malignancy. Most are aggressive, high-grade B cell malignancies and are classified as AIDS Related Lymphomas (ARL). Prior to antiretroviral therapy (ART), the incidence of lymphoma was 60-200-fold higher than that seen in HIV-negative subjects, but this has decreased to 11-25-fold with the widespread use of ART,’ Rapiti said.
She added that most patients in the country access medical care through government health facilities. King Edward VIII Hospital (KEH), where she conducted her study, is a government-funded, tertiary hospital affiliated to UKZN’s Nelson R. Mandela School of Medicine, and is where most ARL in the indigent population are treated. ‘The aim of this original research was to describe the profile, outcome and prognostic variables of ARL treated in a government hospital at the epicentre of the HIV/AIDS pandemic in KwaZulu-Natal, and compare this to data described elsewhere in South Africa and internationally,’ she said.
Local data resulting from Rapiti’s PhD contributes to the formation of an evidence-based guideline for the management of ARL in KZN. The study describes the profile and outcome of the study’s cohort of ARL patients that were treated with combination chemotherapy. ‘Our study showed that the international prognostic systems are applicable to the local population. It found the highest CD4 count in patients with plasmablastic lymphoma, but a surprisingly low incidence of bone marrow involvement. This is being further investigated in another study,’ she said.
Rapiti added that ‘Novel findings were the CD4 count in plasmablastic lymphoma, bone marrow incidence and management of central nervous system (CNS) disease according to symptoms rather than prophylactically.’
Rapiti recently completed another investigator-led initiative for a multi-centre study on the establishment of a full blood count reference interval in South Africa – a national collaboration involving academic units throughout the country. She is also supervising a PhD study on lymphoma patients’ outcome according to HIV status, the sub-type of lymphoma and different therapies offered. Rapiti and another doctor in the department have received funding for myeloma research and the refurbishment of space at KEH to create a dedicated haematology ward. The stakeholders involved in the project are the National Health Laboratory Service (NHLS), Department of Health and Bristol Myers Squibb Foundation.
‘I worked in the UK as a haematologist for a few years, but returned home to raise my family and to specialise. I am passionate about teaching and learning. My dad’s focus was always education, and he instilled this in his kids,’ she said.
Rapiti has a joint appointment between UKZN and the NHLS. She enjoys playing tennis, travelling, reading and writing.
Words: Lunga Memela
Photograph: Abhi Indrarajan