Long-Term Survival of a Patient With Human Immunodeficiency Virus Infection and Hodgkin's Lymphoma

A. Hafeez Diwan, MD, Phd, Jay Umbreit, MD, Beverly P. Nelson, MD

Disclosures

South Med J. 2002;95(8) 

In This Article

Abstract and Introduction

When patients infected with human immunodeficiency virus (HIV) are found to have Hodgkin's lymphoma (HL), it is generally advanced, with involvement of extranodal sites including bone marrow, spleen, and liver, and prognosis tends to be unfavorable. We present the case of a 38-year-old white man who had HIV and HL diagnosed in 1990. Despite presenting with stage IV HL, having recurrence of HL after initially attaining remission, and being hospitalized on several occasions for opportunistic infections, he ultimately achieved complete remission of HL and is alive 9 years after initial diagnosis. This case illustrates that although unusual, prolonged survival of an HIV-infected patient with HL associated with poor prognostic features is possible.

Both high and intermediate grade non-Hodgkin's lymphomas and Hodgkin's lymphoma (HL) have an increased incidence in patients infected with HIV.[1] However, it is difficult to assess whether HL is increased in the setting of HIV infection because HL and HIV frequently occur among patients in a similar age group.[2] Nevertheless, some reports indicate that the incidence of HL is increased in patients infected with HIV, though not to the same extent as non-Hodgkin's lymphoma or Kaposi's sarcoma.[3,4]

Several studies have focused on the clinical presentation and behavior of HL in HIV-infected patients. In the setting of HIV infection, HL is increased among intravenous drug abusers.[5,6,7] Human immunodeficiency virus-related HL is more common in men[5,6] and is characterized by an advanced stage at presentation, the presence of B symptoms (fever, night sweats, or weight loss >10% of body weight), mixed cellularity histology, involvement of bone marrow, and an aggressive clinical course.[5,6,8]

Not surprisingly, therefore, long-term survival of HIV-infected patients with HL is low. One study of 114 patients reported a median survival of 7 months for patients with the acquired immunodeficiency syndrome (AIDS) at the time of HL diagnosis.[5] Based on their findings, Tirelli et al[5] indicated the following favorable risk factors: achievement of complete remission, CD4 counts >250/µL, and no previous diagnosis of AIDS. However, when the diagnosis of HL precedes that of AIDS, the median survival is still low (20 months). In another study of 46 cases, projected 3-year survival was 19%.[6]

We describe a patient in whom HIV infection and HL were diagnosed during the same hospitalization. He received chemotherapy, achieved complete remission initially, and had relapse before achieving complete remission again. He is alive 9 years after initial diagnosis.

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