Pathogenetic and histogenetic features of HIV-associated Hodgkin's disease

Compared with the cases in the general population, Hodgkin's disease (HD) a rising in the HIV setting shows distinctive features in terms of epidemiolo gy. aetiopathogenesis, histopathology and clinical behaviour. Although HD d oes not represent an AIDS-detining condition. recent evidence consistently indicates that HIV-infected individuals have a significantly increased risk of developing HD. HIV-related HD is characterised by the preponderance of aggressive histological subtypes. advanced stage at presentation, and highl y malignant clinical course. Moreover, unlike HD in the general population. the large majority of HIV-related HD cases are pathogenetically linked to Epstein-Barr virus (EBV), with rates of EBV positivity ranging from 80 to 1 00%. Hodgkin and Reed-Sternberg cells of these cases invariably show a stro ng expression of the EBV-encoded latent membrane protein-1 (LMP-1), which f unctions as a constitutively activated tumour necrosis factor (TNF) recepto r-like molecule. Usurpation of physiologically relevant pathways by LMP-1 m ay lead to the simultaneous or sequential activation of signalling pathways involved in the promotion of cell activation. growth, and survival, contri buting thus to most of the features of HIV-related HD. (C) 2001 Elsevier Sc ience Ltd. All rights reserved.