Objective:

To report a rare case of spontaneous regression of stage IV diffuse large B-cell lymphoma (DLBCL) in an HIV-positive patient and review existing literature on the phenomenon, emphasizing its clinical significance.

Key Findings:

• The patient achieved complete remission without cytotoxic therapy after starting cART, with implications for treatment strategies.
• Remission has been sustained for over 36 months, indicating a potential long-term benefit.
• CD4+ T-cell recovery and effective viral suppression correlated with tumor regression, suggesting a critical role of immune function.

Interpretation:

This case suggests that immune reconstitution through cART may play a critical role in the management of HIV-associated lymphoma, potentially leading to spontaneous regression, supported by evidence from similar cases.

Limitations:

• Spontaneous regression cases are exceedingly rare, limiting generalizability.
• The patient declined standard chemotherapy, complicating understanding of treatment efficacy.
• Lack of long-term follow-up data in similar cases limits the ability to draw broader conclusions.

Conclusion:

Early initiation of cART in HIV-positive lymphoma patients is recommended to restore immune function, which may positively influence lymphoma outcomes, as evidenced by this case.