[Hodgkin's disease in patients infected with the human immunodeficiency virus].
BACKGROUND
Hodgkin's disease in patients infected by the human immunodeficiency virus (HIV) is still not part of the definition of acquired immune deficiency syndrome. Nonetheless, this entity has a particular presentation when compared to the disease occurring in immune-competent patients.


BACKGROUND
Increased frequency (> 75%) of advanced anatomical stages and extranodular localizations (Ann Arbor system stages III and IV) has been outlined in HIV-infected patients. Mediastinal involvement is more unusual in immunocompromised than in immune-competent patients. The presence of B symptoms (fever, weight loss, nocturnal sweats) is very frequent. Finally, the predominance of mixed cellularity (type 3) characterizes Hodgkin's disease in immunocompromised patients. Due to either the immunodeficiency, antiretroviral treatments, poor hematological tolerance in response to chemotherapy, or to advanced anatomical stages, disease management may be hampered. Current therapeutical approaches often obtain complete remission; however, some deaths are still related to the disease progression to acquired immune deficiency syndrome.


CONCLUSIONS
From these observations, Hodgkin's disease management in HIV-infected patients relies on therapeutical approaches similar to those used for non infected patients, with some specific recommendations. Chemotherapy should be conducted in the shortest time in order to minimize chemotherapy-induced immunosuppression. Simultaneous use of antiretroviral treatment and reinforced opportunistic infection prophylaxis are of pivotal importance. Finally, the use of hematopoietic growth factors appears to be safe regarding viral replication, but still requires further evaluation.
Département d'hématologie, université de la Méditerranée, institut Paoli-Calmettes, Marseille, France.
R
R
Costello
L
L
Heuberger
N
N
Petit
D
D
Olive
J A
JA
Gastaut
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002423:Cause of Death; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006679:HIV Seropositivity; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D016483:Lymphoma, AIDS-Related / Q000150:complications* / Q000188:drug therapy; D008479:Mediastinal Neoplasms / Q000150:complications; D011379:Prognosis; D012074:Remission Induction
D019380:Anti-HIV Agents
La maladie de Hodgkin chez les patients atteints du virus de l'immunodéficience humaine.