HODGKINS-DISEASE AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - CLINICOPATHOLOGICAL AND VIROLOGICAL FEATURES OF 114 PATIENTS FROM THE ITALIANCOOPERATIVE GROUP ON AIDS AND TUMORS

Purpose: To describe virologic, clinicopathologic, and therapeutic fea tures of a large series of Italian patients with Hodgkin's disease (HD ) and human immunodeficiency virus (HIV) infection. Patients and Metho ds: From November 1986 to March 1994, 114 cases were observed. The rel ationship between Epstein-Barr virus (EBV) and HD was determined by an in situ hybridization technique, immunostaining for EBV-encoded laten t membrane protein-1 (LMP-1) expression, and Southern blotting. Twenty -six patients were included in a prospective study evaluating the comb ination of chemotherapy (CT) with zidovudine. Results: Combined approa ch on EBV study revealed that 14 (78%) of 18 patients were EBV-associa ted. An almost equivalent distribution of EBV subtypes was observed in EBV-carrying cases, indicating that in the HIV setting, type 2 EBV al so may be pathogenetically involved in HD development. In comparing th ese 114 patients with our single-institutional series of 104 HIV-negat ive patients with HD, we observed at presentation a younger median age (29 v 38 years): a prevalence of males (90% v 56%); and a higher perc entage of stage IV disease (52% v 15%), presence of B symptoms (77% v 35%), and extranodol disease (63% v 29%). The complete remission (CR) rate (58%) and median survival (13 months) of patients treated prospec tively were similar to that of patients treated with standard CT regim ens. The statistically significant favorable prognostic factors for su rvival being the following: achievement of CR, CD4+ count greater than 250/mu L, and no prior diagnosis of AIDS at onset of HD. Conclusion: Our virologic findings indicate that HIV-related HD is more closely as sociated with EBV than HD in the general population, The peculiar clin icopathologic findings, the role of some prognostic factors, and the p ossibility of cure of HIV-related HD have been demonstrated.