Introduction
Acquired immunodeficiency syndrome (AIDS) is a condition that results from infection with the human immunodeficiency virus (HIV). HIV specifically targets and destroys the host’s immune system, particularly CD4 + T lymphocytes, leading to a marked reduction in the body’s capacity to combat various infections and certain malignancies [ 1 ]. Once the immune system is sufficiently compromised, patients may experience opportunistic infections and malignancies, which are hallmark characteristics of AIDS [ 2 ].
Hematologic malignancies encompass a group of neoplastic disorders that originate in the blood, bone marrow, or lymphatic system, including leukemia, lymphoma, and multiple myeloma [ 3 ]. These neoplasms arise from the aberrant proliferation or differentiation of hematopoietic or immune cells. Notably, HIV infection is associated with an elevated risk of hematologic malignancies, with lymphoid tumors, particularly non-Hodgkin lymphoma (NHL), being particularly prominent. HIV-associated NHL accounts for over half of all cancers that are classified as AIDS-defining and continues to be a leading cause of cancer-related mortality among individuals living with HIV. Prior to the introduction of highly active antiretroviral therapy (HAART), the risk of developing AIDS-related NHL in HIV-infected individuals was estimated to be 60 to 200 times greater than that observed in the general population [ 4 ]. Despite advancements in therapeutic interventions, the complexity of these malignancies, coupled with their elevated incidence and mortality rates—especially in patients whose compromised immune systems impede tumor recognition—remains a significant public health concern [ 5 ]. Patients with AIDS often necessitate personalized and cautious treatment regimens to prevent further immunosuppression, particularly regarding the compatibility of antiretroviral therapy (ART) with treatments for hematologic cancers [ 6 , 7 ]. Given the significantly increased and persistent risk, a thorough understanding of the intricate interplay between HIV/AIDS and hematologic malignancies is essential for enhancing patient management and outcomes [ 8 ].
Bibliometric analysis offers valuable insights into the developmental trends, impact, and collaborative networks within scientific disciplines. It accomplishes this by quantitatively analyzing bibliographic metadata, including publication trends, keyword co-occurrence, and author collaboration networks, thereby elucidating the structure and evolutionary patterns of a research domain. This methodology contrasts with traditional review articles, which generally emphasize qualitative integration and evaluation of research content [ 9 ]. Bibliometric analysis elucidates critical information such as research hotspots, interrelationships among authors and institutions, and journal impact, aiding researchers in understanding the evolution and trends within academia. Previous bibliometric analyses focused on HIV/AIDS have not adequately addressed the relationship between HIV/AIDS and hematologic malignancies [ 10 – 12 ]. This study, therefore, aims to address this gap through a focused bibliometric analysis. Specifically, its objectives are to comprehensively map the intellectual landscape of research at the intersection of HIV/AIDS and hematologic malignancies, identify key trends and influential entities, and delineate critical areas for future investigation, ultimately revealing the evolving research hotspots, developmental dynamics, and promising future directions within this vital field.
Materials and methods
Search strategies and data collection
To comprehensively analyze research trends in the field of HIV/AIDS and hematological malignancies, a literature search was conducted within the Web of Science Core Collection (WoSCC). WoSCC was selected for its high reliability, stringent journal selection criteria, and extensive coverage of high-quality, peer-reviewed, interdisciplinary literature [ 13 ]. Moreover, as one of the most frequently used databases for bibliometric studies, WoSCC provides detailed citation and author information crucial for collaborative network analysis [ 14 ]. Specifically, the Science Citation Index Expanded (SCIE) and Social Sciences Citation Index (SSCI) were utilized as data sources due to their strong relevance to biomedical and health sciences research. The search strategy was defined as: TS = (“Acquired Immune Deficiency Syndrome” OR AIDS OR “Acquired Immuno-Deficiency Syndrome” OR HIV OR “Human Immunodeficiency Virus”) AND TS = ((Hematologic* OR Hematopoietic*) AND (Neoplasm* OR Cancer* OR Malignanc*) OR “Blood Cancer”). This strategy utilized the “Topic Search” (TS) field to scan titles, abstracts, and keywords, effectively combining terms with Boolean operators to ensure broad yet focused retrieval [ 15 ]. This strategy identified all English original articles published between 1979 and August 2024. This timeframe was chosen to include all relevant literature on HIV/AIDS and hematological malignancies since the earliest indexed records, ensuring a thorough examination of both historical and recent research trends. All searches were performed on August 12, 2024, to effectively mitigate temporal bias. The initial search from the WoSCC retrieved 2,029 studies. From these, 508 reviews, 8 editorials, 11 letters, 28 conference abstracts, 39 non-English publications, and 99 other document types were excluded.
Statistical analysis
Using Microsoft Excel 2016, we identified and calculated relevant data to obtain bibliometric indicators. These indicators included the annual number of publications, citation frequency, average citation frequency, journal names, journal impact factors, publication countries/regions, publishing institutions, and authors.
VOSviewer was employed for visualizing co-occurrence networks and keyword co-occurrence networks. This versatile tool is instrumental in visualizing collaboration among institutions, author co-occurrence, and citation and co-citation networks [ 16 ]. Additionally, CiteSpace was utilized for keyword burst detection and co-occurrence analysis. For CiteSpace, the time slice was set to one year, and keywords were specified as the node type. A threshold of the top 5 keywords was applied for each time period, incorporating pathfinding network pruning and merging methods [ 17 ]. In the visualized co-occurrence networks, nodes represent countries, institutions, authors, or journals, and are grouped by collaboration. Node size indicates the publication volume. Link strength (LS), denoted by line thickness, signifies the intensity of collaboration [ 18 ]. For a robust statistical framework and detailed insights into citation patterns and research impact, the R package “Bibliometrix” was applied for bibliometric analysis [ 19 ]. Concurrently, the Journal Citation Reports (JCR) was utilized to determine the impact factor (IF), assessing journal influence [ 20 – 22 ].
Results
Overview
The study flow chart was shown in Fig. 1 . A total of 1336 publications related to HIV/AIDS and hematological malignancies were included. The publications involved 10,198 authors, spread across 594 different journals, and cited a total of 47,259 references. From 1994 to 2024, the publication trend for research on HIV/AIDS had generally shown a steady increase. We observed that the number of papers published had continued to increase from the year 2000 onward and had peaked in 2023 with 95 papers. The trend had been well-fitted by the exponential function y = 11.113e 0.0692x (R 2 = 0.8946), suggesting that growth will likely continue in the future (Fig. 2 ).
Fig. 1 Flowchart of the literature screening process
Fig. 2 Annual number of publications
Analysis of the countries
In the investigation of HIV/AIDS and hematological malignancies, the top ten contributing countries represented 75% of the global total (Fig. 3 A and Table S1). In terms of publication volume, the United States stands out as the primary contributor, with 533 articles, representing 39.9% of the total. China follows, with 106 articles, making up 7.9%. Single-country publications (SCPs) and multi-country publications (MCPs) were color-coded to indicate the extent of international collaboration. The United States showed an MCP ratio of 0.144, while Chinese was 0.104. Overall, academic output from the top five contributing countries demonstrated a general upward trend (Fig. 3 B), with the United States exhibiting the most significant growth in this field. Regarding citations, the United States again led, amassing a total of 22,250 citations. In contrast, Australia distinguished itself by achieving the highest average citations, with 62.2 citations per article. Based on the national collaboration network data, 49 countries had published five or more articles. The United States maintained its leading position in the collaboration network (total link strength = 248), followed by France (total link strength = 153) and the United Kingdom (total link strength = 147) (Fig. 3 C).
Fig. 3 Analysis of countries and institutions. A Distribution of corresponding author’s publications by country. B Growth in publication volume from major research countries. C Visualization map depicting the collaboration among different countries. D Top ten institutions by article count and rank. E Growth in publication volume from major research institution. F Visualization map depicting the collaboration among different institutions
Analysis of institutions
As shown in Fig. 3 D, the top 10 institutions with the most publications had the Université Paris Cité leading the way with 166 articles, followed by the Paris Public Hospital Group (APHP) with 165 articles. The publication output of these leading institutions has shown steady growth (Fig. 3 E). Among the 127 institutions involved in international collaborations with at least five articles, Fred Hutchinson Cancer Center (total link strength = 82) had the highest number of collaborations, followed by Memorial Sloan Kettering Cancer Center (total link strength = 74) and Dana-Farber Cancer Institute (total link strength = 70) (Fig. 3 F).
Analysis of journals
In HIV/AIDS and hematological malignancies research, the number of articles published in the top five journals was on the rise (Fig. 4 A). Blood was the leading journal with the highest number of articles (29), an h-index of 26, an impact factor of 21, and 3,082 total citations, making it the most cited journal (Table S2). To describe the relationships between journals, co-occurrence and coupling networks were constructed. The journal co-occurrence networks identified 54 journals with a minimum of five citations. Among these, the Blood , PLOS ONE , and Biology of Blood and Marrow Transplantation had the top three highest total link strengths, with 24, 15, and 15 respectively (Fig. 4 B), while the journal coupling network analysis revealed that PLOS ONE, Blood, and Clinical Infectious Diseases were the top three journals with the highest total link strength, with respective counts of 501, 413, and 386 (Fig. 4 C).
Fig. 4 Analysis of journals and authors. A Growth in publication volume from major journals. B The co-occurrence networks of journals. C The coupling networks of journals. D Active period of key authors in the field, indicating their publication trends over time. E Visualization map depicting the collaboration among different authors
Analysis of the authors
Several authors demonstrated high impact in this research area, including Azoulay Elie, Kiem Hans-Peter, and June Carl H. Since 2007, Elie published 13 articles, accumulating 737 citations, making him a highly cited author in this field. He has maintained consistent activity since 2007, with notable productivity peaks in 2021 and 2022 ( Table S3 , Fig. 4 D). The author collaboration network map indicated that Azoulay Elie (total link strength = 63) had the highest number of international collaborations, followed by Darmon Michael (total link strength = 39) and Schwebel Carole (total link strength = 33) (Fig. 4 E).
Analysis of the keywords
As shown in Fig. 5 A, the early research focus was on “neutropenia patients” and “progenitor cells” (purple). Over time, interest shifted towards “pneumocystis pneumonia” and “pneumocystis yeli pneumonia” (green). In recent years, research has increasingly emphasized “outcomes” and “mortality.” Among the top 20 most-cited keywords, “bone marrow transplant” was the earliest emerging keyword (1994) and had the highest burst intensity. Meanwhile, terms such as “outcome,” “classification,” “diagnosis,” and “risk factors” have gained prominence and continue to show strong citation bursts in 2024 (Fig. 5 B).
Fig. 5 Analysis of keyword. A Visual analysis of keyword co-occurrence network analysis. B Top 20 Keywords with the Strongest Citation Bursts
Discussion
This study analyzed the evolving research landscape in the fields of HIV/AIDS and hematological malignancies. As the analysis revealed, the dynamic shifts in research hotspots and trends within HIV/AIDS and hematological malignancies offer crucial insights for advancing patient care. The historical shift from managing acute infections to focusing on long-term clinical outcomes underscores the progress made and the challenges that remain. Continued emphasis on precise diagnostics, personalized treatment strategies, and optimizing interventions like bone marrow transplantation will be paramount to improving patient prognosis and survival.
Key findings
While HIV isn’t inherently carcinogenic, its link to immunosuppression contributes to AIDS-defining cancers, specifically Kaposi’s sarcoma, invasive B-cell NHL, and cervical cancer [ 23 ]. A highly influential review published in Blood in 2022 likely heightened researcher attention on this field [ 24 ], leading to a significant peak in publication volume in 2022. The United States emerged as a leader across various research aspects. This dominance was attributable to the nation’s robust biomedical research infrastructure, high prevalence and incidence of HIV and hematological malignancies, substantial research investment, and long-established international collaborations [ 25 ]. Université Paris Cité, Assistance Publique - Hôpitaux de Paris, and Harvard University published the most articles and demonstrated close collaborative ties. Influential authors, such as Azoulay Elie, distinguished themselves through sustained contributions, leadership in significant collaborative projects, and frequent citation by peers. These authors often led or participated in large cohort studies and clinical trials, further elevating their output and impact [ 26 , 27 ]. The Blood journal was identified as the most influential publication in this research area due to its high impact factor, broad hematological scope, and rigorous peer-review process, which attracts top-tier submissions [ 24 , 28 ].
Current research hotspots
Keyword co-occurrence analysis reveals a dynamic evolution in research hotspots within the field of HIV/AIDS and hematological malignancies, shifting from initial concerns about opportunistic infections to a focus on clinical outcomes and precise diagnostic and prognostic strategies. Early research primarily centered on “neutropenia patients” and “progenitor cells.” This focus reflected concerns about opportunistic infections and bone marrow suppression in immunocompromised individuals. Studies highlighted that neutropenic patients, particularly those with hematological malignancies, faced increased risks of opportunistic infections due to impaired neutrophil function and delayed immune reconstitution [ 29 ]. The role of progenitor cells in restoring hematopoiesis and modulating immune responses was explored, especially in the context of allogeneic HSCT, where donor-derived immune cells influence patient recovery [ 30 ]. Additionally, research indicated that neutropenic individuals experienced higher susceptibility to respiratory infections, including those caused by respiratory syncytial virus (RSV), further complicating their clinical management [ 31 , 32 ].
Mid-term emerging research indicated a shift toward “Pneumocystis pneumonia” and “Pneumocystis jirovecii pneumonia,” highlighting the growing interest in opportunistic fungal infections as a major cause of morbidity in AIDS patients with hematological malignancies. These infections exploited weakened immune defenses, leading to severe pulmonary complications. Research indicated that hematological malignancies, particularly in non-HIV patients, were increasingly associated with Pneumocystis infections, with corticosteroid use and chemotherapy-induced neutropenia being major risk factors [ 33 ]. Furthermore, advancements in molecular diagnostics, such as PCR-based assays, improved the detection and characterization of Pneumocystis species, shedding light on their epidemiology and drug resistance patterns [ 34 ]. Despite prophylactic strategies, treatment remained challenging due to the development of resistance to standard therapies like sulfamethoxazole-trimethoprim, necessitating the exploration of alternative antifungal agents [ 35 ].
In recent years, research on HIV-associated hematological malignancies increasingly emphasized “outcomes” and “mortality,” reflecting a shift from mechanistic studies to clinical prognosis and survival analysis. Recent studies indicated a rising incidence of hematological malignancies among HIV patients, particularly diffuse large B-cell lymphoma and Hodgkin lymphoma, which were often diagnosed at advanced stages [ 36 ]. Additionally, research highlighted the impact of ART on patient prognosis, though a significant proportion of patients continued to experience high mortality rates due to immunosuppression, treatment-related complications, and opportunistic infections [ 37 ]. Global cohort studies demonstrated that the death rate among HIV patients with hematological malignancies remained substantially higher than in the general population, with an increasing incidence of non-AIDS-defining malignancies (NADMs) [ 38 ]. While immune checkpoint inhibitors showed promise in the treatment of HIV-associated lymphomas, concerns about Immune Reconstitution Inflammatory Syndrome (IRIS) continued to pose challenges for their clinical application [ 39 ].
Future research directions
Monitoring keyword bursts effectively helps identify dynamic changes in research trends, pointing towards future research directions. The most valuable emerging keyword related to “bone marrow transplant” had the longest duration of emergence, suggesting that ongoing advancements in transplantation techniques will be crucial for treating HIV/AIDS and hematological malignancies in the future [ 40 ]. Recent studies indicate that bone marrow transplantation can notably improve long-term survival and quality of life for HIV patients, especially those with ART failure [ 41 ]. This suggests that ongoing advancements in bone marrow transplantation techniques will continue to be crucial for the treatment of HIV/AIDS and hematological malignancies in the future.
The research on patient outcomes in individuals with AIDS and hematological malignancies has emphasized survival disparities, treatment responses, and long-term complications. Studies have demonstrated that patients with concurrent AIDS and hematologic malignancies experience significantly worse prognoses due to immunosuppression, leading to higher rates of opportunistic infections and treatment-related toxicities [ 42 ]. Despite advancements in ART and hematologic treatments, these patients continue to face increased mortality compared to non-HIV-infected individuals with similar malignancies [ 43 ].
The burst trends of keywords such as “outcome,” “classification,” “diagnosis,” and “risk factors” in 2024 suggest that researchers need to focus their attention on precise diagnostic and prognostic strategies for HIV/AIDS and hematological malignancies. Recent evidence suggests that immune reconstitution plays a critical role in survival outcomes. Delayed CD4 + T-cell recovery following chemotherapy or hematopoietic stem cell transplantation has been associated with poor prognosis, highlighting the importance of early immune monitoring and tailored interventions [ 44 ]. Furthermore, emerging data indicate that the use of immune checkpoint inhibitors in certain hematologic malignancies, while promising, may pose additional risks for immune-related adverse events in patients with HIV, requiring cautious therapeutic balancing [ 45 ].
Additionally, recent studies have refined the classification of HIV-related hematological malignancies, highlighting different subtypes with distinct clinical and pathological characteristics. Notably, HIV-related lymphomas, such as diffuse large B-cell lymphoma and Hodgkin lymphoma, have emerged as the most prevalent malignancies, often presenting at advanced stages due to immune dysregulation [ 46 ]. Additionally, HIV has been linked to an increased incidence of leukemia and plasma cell disorders, with chronic immune activation and viral oncogenesis playing a role in disease progression [ 47 ]. Advances in molecular profiling have also led to the identification of novel biomarkers distinguishing HIV-associated hematologic malignancies from their non-HIV counterparts, aiding in more precise classification and treatment stratification [ 48 ]. Advancements in diagnostic techniques have also contributed to the development of this research field. The early diagnosis of HIV infection typically relies on HIV antibody testing, HIV RNA testing, and CD4 + T cell counts, which effectively identify the infection and guide subsequent treatment [ 49 ]. The diagnosis of hematologic malignancies generally depends on hematological examinations, bone marrow biopsies, and imaging studies to determine the type of tumor and its extent of spread [ 50 ]. The application of liquid biopsy technology has enabled early screening through the detection of circulating tumor DNA (ctDNA) in the blood, thereby improving patient prognosis [ 51 ]. Additionally, the introduction of single-cell sequencing technology has deepened the study of the tumor microenvironment, providing new evidence for personalized treatment [ 52 ]. For HIV-infected individuals, early immune monitoring and timely intervention are crucial, as research indicates that enhancing immune system monitoring can effectively reduce the incidence of hematologic malignancies [ 24 ].
Similarly, the research findings suggest that prognostic strategies for patients with HIV/AIDS and hematological malignancies should not be overlooked. Long-term complications, including chronic inflammation, cardiovascular disease, and secondary malignancies, are increasingly recognized as significant factors affecting patient survival [ 53 ]. Persistent immune dysregulation and inflammation in HIV-infected patients contribute to an elevated risk of treatment-related toxicities and organ dysfunction, underscoring the need for integrated long-term management strategies [ 54 ]. Additionally, disparities in access to care remain a critical determinant of patient outcomes. Socioeconomic factors, delays in diagnosis, and limited access to advanced treatments in low-resource settings contribute to poor survival rates in certain populations [ 55 ]. Addressing these disparities through global health initiatives and equitable healthcare access is essential for improving long-term prognosis in this vulnerable patient group. Especially under the influence of risk factors such as COVID-19, the risk factors for mortality in patients with HIV/AIDS and hematological malignancies have become more pronounced. Patients with moderate to severe immunodeficiency may experience persistent infections, with viral particles remaining for extended periods without clear inflammatory or resolution phases [ 56 ]. Given these complexities, future research should focus on tailored therapeutic approaches, including optimized antiviral strategies, immunomodulatory interventions, and personalized prognostic plans, to improve the survival outcomes of this vulnerable population [ 57 , 58 ].
Advantages and limitations
Relying on a single literature database may result in the omission of relevant studies indexed in other sources, potentially limiting the comprehensiveness of the findings. Excluding grey literature and unpublished research can also lead to an incomplete representation of emerging evidence. Furthermore, restricting the analysis to English-language publications might overlook significant studies in other languages, introducing potential language bias. While keyword analysis can highlight research hotspots and trends, it may not fully capture all relevant research questions or technological advancements in the field. Additionally, due to the nature of bibliometric analysis, the results reflect trends in research output rather than direct clinical outcomes.
Despite these limitations, this study provides valuable insights, including the identification of research trends and international collaboration networks in HIV/AIDS and hematological malignancies, which can serve as important references for future research efforts. The use of multiple analytical tools enhanced data reliability and improved the visualization of research outcomes, making the dynamics of the field more comprehensible.
In conclusion, the evolving research landscape in HIV/AIDS and hematological malignancies, as revealed by our analysis, offers crucial insights for advancing patient care. The historical shift from managing acute infections to focusing on long-term clinical outcomes underscores the progress made and the challenges that remain. Moving forward, continued emphasis on precise diagnostics, personalized treatment strategies, and the optimization of interventions like bone marrow transplantation will be paramount to improving patient prognosis and survival. This dynamic field necessitates integrated, multidisciplinary approaches to address complex patient needs and adapt to emerging risk factors, ultimately guiding efforts to enhance the quality of life for this vulnerable population. Researchers should leverage these insights to prioritize collaborative studies and develop innovative solutions that bridge the gap between current challenges and future therapeutic advancements.
Electronic supplementary material
Supplementary Material 1.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Qiwen Zhou and Hao Sun contributed equally to this work.
Acknowledgements
Not applicable.
Author contributions
(I) Conception and design: Qiwen Zhou (II) Administrative support: Haiyan Min (III) Data analysis and interpretation: Hao Sun (IV) Manuscript writing: Qiwen Zhou, Hao Sun, Haiyan Min, Shanshan Fan, Lan Luo, Jianhua Ji, Zejiao Jiang.(V) Final approval of manuscript: Qiwen Zhou, Hao Sun, Haiyan Min, Shanshan Fan, Lan Luo, Jianhua Ji, Zejiao Jiang.
Funding
This study was supported by Yunnan Clinical Research Center for Infectious Disease (AIDS) (202405AJ310002), and Reserve Talents Project for Young and Middle Aged Academic and Technical Leaders of Yunnan Province (202305AC160021).
Data availability
All data generated or analyzed during this study are included in this article and supplementary information files.
Declarations
Ethics approval and consent to participate
This article is a bibliometric analysis. The data for this study were obtained from publicly available databases and published literature data and does not require ethical approval and written informed consent.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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