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Research Article: Caregiver burden and malnutrition in patients with HIV-associated lymphoma: indirect pathways via symptom distress and family closeness, and a test of resilience as a mediator

Date Published: 2026-09-28

Abstract:
Malnutrition is a frequent and clinically significant complication in patients with HIV-associated lymphoma, adversely affecting treatment tolerance, prognosis, and quality of life. Although disease-related and immunological determinants of malnutrition have been widely reported, the potential psychosocial pathways—particularly the role of caregiver burden—in patients with HIV-associated lymphoma remain insufficiently characterized. This study aimed to identify key determinants of malnutrition and to examine whether caregiver burden exerts indirect effects through symptom distress and psychosocial factors. This single-center cross-sectional study included 200 patients with HIV-associated lymphoma and their family caregivers. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), with the total score analyzed as a continuous outcome. Symptom burden, caregiver burden, psychological resilience, and family closeness were assessed using standardized instruments. Univariable and multivariable linear regression analyses were conducted using HC3 heteroscedasticity-consistent inference. Indirect statistical associations were examined using bootstrap analyses, followed by exploratory subgroup and sensitivity analyses. Higher symptom burden and IPI risk were associated with higher PG-SGA total scores, whereas higher CD4?+?T-cell counts and serum albumin concentrations were associated with lower scores (all p ??0.005). Age, sex, and caregiver burden were not independently associated with PG-SGA score. Exploratory analyses provided no statistically supported evidence of an indirect association through symptom burden or of differences by age, sex, or CD4?+?T-cell count. Sensitivity analyses produced consistent conclusions. Nutritional status in patients with HIV-associated lymphoma was associated mainly with symptom burden, immune status, serum albumin, and lymphoma prognostic risk. Caregiver burden showed neither an independent association with PG-SGA score nor a confirmed indirect association through symptom burden. Larger multicenter longitudinal studies are needed to clarify the temporal relationships among caregiver burden, psychosocial factors, and nutritional status.

Introduction:
Malnutrition is a frequent and clinically significant complication in patients with HIV-associated lymphoma, adversely affecting treatment tolerance, prognosis, and quality of life. Although disease-related and immunological determinants of malnutrition have been widely reported, the potential psychosocial pathways—particularly the role of caregiver burden—in patients with HIV-associated lymphoma remain insufficiently characterized. This study aimed to identify key determinants of malnutrition and to examine…

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