Hodgkin'S disease associated with human immunodeficiency virus infection. A clinical study of 46 cases

Abstract

BACKGROUND: Hogdkin's disease is not an acquired immunodeficiency syndrome (AIDS)-defining illness. However, Hodgkin's disease associated with human immunodeficiency virus (HIV) infection has a different natural history and therapeutic outcome than in the general population of Hodgkin's disease patients. METHODS: The authors studied the epidemiologic and clinicopathologic features and therapeutic outcomes of 46 patients with Hodgkin's disease associated with HIV infection collected from a cooperative study of nine hospitals in Madrid, Spain. RESULTS: Forty-three (93.5%) of the subjects were men and three (6.5%) were women, with a mean age of 26.9 years. Thirty-nine (84.8%) were intravenous drug users and four (8.7%) were homosexuals. In 43 patients (93.5%), Hodgkin's disease was the first manifestation of HIV infection. In 16 patients (34.8%), AIDS developed after the diagnosis of Hodgkin's disease. Histologic subtypes were mixed cellularity (41.3%), lymphoid depletion (21.7%), nodular sclerosis (21.7%), and lymphocytic predominance (4.3%). At diagnosis, 89.1% had advanced stages (III,IV), 82.6% had B symptoms, and 41.3% had bone marrow involvement. Of 27 evaluable patients treated with chemotherapy, 44.4% had a complete response (16.7% relapsed) and 37% had a partial response. Median survival was 15 months (range, 1-44 months). Projected 3-year survival rate was 19%, and projected event-free survival rate was 22% at 30 months. Adverse prognostic factors for survival in univariate analysis were B symptoms, no response to chemotherapy, hemoglobin levels less than 11 g/dl, leukocyte count less than 4500/mm3, total lymphocyte count less than 1000/mm3, CD4 lymphocyte count less than 200/mm3, and alkaline phosphatase level greater than 300 IU/l. CONCLUSIONS: Hodgkin's disease associated with HIV infection is more frequent among intravenous drug addicts, and the clinical course is different in these patients from that in the general population of Hodgkin's disease patients, showing high frequency of advanced stages, unfavorable histologic subtypes, poor therapeutic response, and short survival time.