Hodgkin's disease in patients infected with human immunodeficiency virus: Frequency, presentation and clinical outcome

We report the frequency, presenting characteristics, progression-free survi val, event-free survival, overall survival and AIDS-free survival of patien ts with previously untreated Hodgkin's disease (HD) in the setting of infec tion by human immunodeficiency virus (HIV). To accomplish this we retrospec tively reviewed all untreated patients presenting to the University of Texa s M.D, Anderson Cancer Center between July 1985 and August 1999 with HD and HIV infection. All available records were reviewed to determine presentati on, clinical characteristics, treatment outcome, progression-free survival and overall survival. We identified 887 patients with HD and 3,500 with Non -Hodgkin's Lymphoma (NHL). The ratio of NHL to HD in HIV-negative versus HI V-positive patients was 3.9 versus 6.9, respectively. There were 14 HIV-pos itive patients with HD and 97 with NHL. The median age of the HN-positive H D patients was 33 years, and 13 were male. Three patients had Acquired Immu ne Deficiency syndrome (AIDS) at the time of HD diagnosis, and seven had B- symptoms. Ann Arbor stage was I in one, II in three, LII in four and IV in six patients. Mixed cellularity histology was seen in eight, bone marrow in volvement in five and extranodal disease in seven patients. Four patients h ad elevated serum lactate dehydrogenase, three low serum albumin, and nine elevated serum beta2-microglobulin, The median CD4 count was 160/mul. Eleve n patients received ABVD or equivalent regimens, followed by radiotherapy i n five. One patient was treated with COPP and radiotherapy, one with NOVP a nd radiotherapy and one only with radiotherapy. All patients received some antiretroviral therapy, but it was variable over the years. With a median f ollow-up of 64 months for survivors, the projected 5-year progression-free survival was 64%, event-free survival 45%, overall survival 54% and AIDS-fr ee survival 45%. Six patients died of complications arising from HIV infect ion, including one patient who had preexisting AIDS at HD presentation. Two patients died of HD, without developing other conditions diagnostic of AID S. We conclude that in our referral patient population HIV infection is ass ociated with preferential development of NHL rather than HD, which appears curable with standard treatment regimens. Since HIV-related deaths exceed t hose caused by HD, future investigation should focus on integration of chem otherapy and highly active antiretroviral therapy.