HODGKINS-DISEASE IN HIV-POSITIVE PATIENTS

Introduction. - Hodgkin's disease in patients infected by the human im munodeficiency virus (HIV) is still not part of the definition of acqu ired immune deficiency syndrome. Nonetheless, this entity has a partic ular presentation when compared to the disease occurring in immune-com petent patients. Current knowledge and key points. - Increased frequen cy (> 75%) of advanced anatomical stages and extranodular localization s (Ann Arbor system stages III and IV) has been outlined in HIV-infect ed patients. Mediastinal involvement is more unusual in immunocompromi sed than in immune-competent patients. The presence of B symptoms (fev er, weight loss, nocturnal sweats) is very frequent. Finally, the pred ominance of mixed cellularity (type 3) characterizes Hodgkin's disease in immunocompromised patients. Due to either the immunodeficiency, an tiretroviral treatments, poor hematological tolerance in response to c hemotherapy, or to advanced anatomical stages, disease management may be hampered. Current therapeutical approaches often obtain complete re mission; however, some deaths are still related to the disease progres sion to acquired immune deficiency syndrome. Future prospects and proj ects. - From these observations, Hodgkin's disease management in HIV-i nfected patients relies on therapeutical approaches similar to those u sed for non infected patients, with some specific recommendations. Che motherapy should be conducted in the shortest time in order to minimiz e chemotherapy-induced immunosuppression. Simultaneous use of antiretr oviral treatment and reinforced opportunistic infection prophylaxis ar e of pivotal importance. Finally, the use of hematopoietic growth fact ors appears to be safe regarding viral replication, but still requires further evaluation. (C) 1998 Elsevier, Paris.