Hodgkin disease developing in patients infected by human immunodeficiency virus results in clinical features and a prognosis similar to those in patients with human immunodeficiency virus-related non-hodgkin lymphoma

BACKGROUND. Unlike aggressive non-Hodgkin lymphoma (NHL), Hodgkin disease ( HD) develops rarely in patients who are infected by human immunodeficiency virus (HIV), and its characteristics are not well defined. The authors anal yzed the clinicopathologic and prognostic features from a consecutive serie s of patients with HIV-associated HD who were observed at their institution and compared them with the features observed in a concurrent series of pat ients with systemic HIV-related NHL. METHODS. Eighteen patients with HIV infection who were diagnosed and treate d uniformly from 1985 to 1999 at a single primary referral center were anal yzed. Their demographic, immunologic, and clinicopathologic features; respo nses to treatment; and outcomes were compared with those of 98 patients wit h systemic NHL of aggressive histology who were diagnosed during the same p eriod and with 165 HIV negative patients with HD. RESULTS. HIV-associated HD and NHL occurred in patients with similar age, g ender, HIV risk factors, degree of immunodeficiency, and incidence of previ ous acquired immunodeficiency syndrome. The clinical presentation of HIV-as sociated HD was atypical and was more aggressive than in HIV negative patie nts (mediastinal involvement, 11%; Stage III-IV, 84%; B symptoms, 83%). It was similar to HIV-related NHL, except for the frequency of extralymph node disease, which was seen less frequently in patients who had HD (56%) compa red with patients who had NHL (82%; P = 0.025), and the frequency of bone m arrow involvement, which was unexpectedly higher in patients who had HD (50 %) compared with patients who had NHL (20%; P = 0.011). Potentially curativ e treatment was administered to 77% of patients with HD and 66% of patients with NHL. Complete remission and disease recurrence rates as well as disea se free and overall survival rates did not differ significantly, with estim ated overall survival at 5 years of 24% in patients with HD and 23% in pati ents with NHL. CONCLUSIONS. HIV-associated HD is an aggressive disease with demographic, c linical, and prognostic features nearly identical to those of HIV-related N HL. Cancer 2001;92:2739-45. (C) 2001 American Cancer Society.