Body mass index and hemophagocytic lymphohistiocytosis: a risk assessment in HIV-positive leukemia patients.

Secondary hemophagocytic lymphohistiocytosis (sHLH) is a severe hyperinflammatory syndrome characterized by excessive activation of the immune system, leading to multiorgan dysfunction and high mortality. This review explores the relationship between body mass index (BMI) and the risk of sHLH in leukemia patients living with human immunodeficiency virus (HIV). In this population, the compounded effects of immunosuppression and inflammatory conditions present unique challenges, making it crucial to understand the role of BMI in modulating these risks. Leukemia and HIV independently contribute to significant immune system dysregulation. When these conditions coexist, patients face increased susceptibility to infections and inflammatory disorders. BMI, an indicator of nutritional and metabolic status, can further influence immune responses. Low BMI, often associated with malnutrition, impairs immune function, while high BMI, linked to obesity, promotes chronic inflammation. Both extremes can exacerbate the cytokine storm characteristic of sHLH, leading to more severe clinical outcomes. Regular monitoring and addressing nutritional status through tailored interventions can potentially mitigate the risk of sHLH. A multidisciplinary approach, integrating the expertise of oncologists, infectious disease specialists, nutritionists, and immunologists, is essential for optimizing patient care and improving outcomes in this vulnerable population. Further research is necessary to deepen our understanding of the mechanisms linking BMI to sHLH and to develop evidence-based guidelines for clinical practice.