Treatment of human immunodeficiency virus-associated Hodgkin disease. Is there a clue regarding the cause of Hodgkin disease?
BACKGROUND
The occurrence of human immunodeficiency virus (HIV)-associated Hodgkin disease (HD) offers a unique opportunity to study the cause of HD and compare HIV-HD with the well-characterized HIV-non-Hodgkin lymphoma (NHL).


METHODS
Eight patients with HIV-HD and 17 with HIV-NHL were treated.


RESULTS
The complete remission (CR) rate in HIV-HD was 100% with mechlorethamine, vincristine, procarbazine, and prednisone or doxorubicin, bleomycin, vinblastine, and dacarbazine (median survival, > 38.0 months). HIV-NHL patients were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CR, 80%; median survival, 13.0 +/- 1.3 months). Durable CR was achieved with one to six cycles of chemotherapy (median, 4). There were no late relapses. The difference between the survival rate associated with chemotherapy-treated HIV-HD and chemotherapy-treated HIV-NHL approached statistical significance (P = 0.06). Analysis indicated that all patients with HIV-HD (n = 8) may have acquired HIV through intravenous drug abuse (IVDA) compared with 1 of 17 patients with HIV-NHL (P = 0.0001). A combined analysis (metaanalysis) of 157 patients with chemotherapy-treated HIV-NHL and 51 with chemotherapy-treated HIV-HD confirmed the significantly better survival of those with HIV-HD (P < 0.0001).


CONCLUSIONS
Standard combination chemotherapy, truncated as necessary, offers survival outcomes that are at least equivalent and, perhaps, superior to previously published experimental approaches for HIV-NHL and HIV-HD. HIV-HD has a significantly better prognosis than HIV-NHL and is associated with IVDA. These data suggest that the etiologic agents of HIV-HD and HIV-NHL may be transmissible, identifiable, and unique.
Newcom
S R
SR
Department of Medicine, School of Public Health, Emory University School of Medicine, Atlanta, Georgia 30303.
Ward
M
M
Napoli
V M
VM
Kutner
M
M
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007958:Leukocyte Count; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy; D008297:Male; D016019:Survival Analysis