Human Immunodeficiency Virus Associated Hodgkin's Disease: Report of 45 Cases from the French Registry of HIV-Associated Tumors

Abstract

Clinical and pathological characteristics as well as outcome of 45 Hodgkin's disease (HD) cases collected by the French registry of HIV-associated tumors between January 1987 and December 1989 (all clinically staged according to the Ann Arbor system) were analyzed and compared with those of a cohort of 407 patients with clinical stages (CS) IA to IVB enrolled between September 1981 and August 1988 in a multicentric clinical trial. The route of HIV infection, initial CD4 cell count at the time of HD diagnosis and CDC class of HIV infection were studied as well as the progression to AIDS onset were recorded.

HIV-HD is characterized by a predominance of advanced CS (75%), B symptoms (80%) and mixed cellularity histology (49%), as well as by early bone marrow involvement (24%); a specific feature is the rare occurrence of mediastinal involvement (13% in HIV-HD versus 71% in primary HD). With standard therapies, 79% of the patients achieved a complete remission, but hematological and infectious complications were very frequent. The proportion of intravenous drug abusers (IVDA) in HIV-HD (38%) is higher than in French HIV-infected population as a whole (20.8%). Median CD4 cell count was 306/μl at the time of HD diagnosis, while only 5 cases (11%) were preceded by an AIDS manifestation; progression to AIDS rate was 94% at 2 years. Overall 2-year survival was 41%, with 71% for patients with an initial CD4 cell count over 300/ul and 0% for those with CD4 cell count lower than 300/μl (p < 0.01); opportunistic infections were the most frequent cause of death.

HIV-HD seems to occur preferentially in. IVDA; it has a particular profile when compared to primary HD, with a predominance of mixed cellularity type, a high frequency of advanced CS, and a high proportion of patients without mediastinal involvement. Standard HD therapy seems to be efficient but excessively toxic in this group of patients.

Key Words:

• HIV infection
• Hodgkin's disease