Hodgkin’s Lymphoma in HIV-Infected Patients

Abstract

Aim. To assess clinical and laboratory characteristics of the unique category of HIV-positive patients with hepatitis C or B co-infection combined with Hodgkin’s lymphoma (HL). Materials & Methods. The paper provides data on 85 HIV-positive patients with HL followed-up at the Department of Hematology and Secondary Immunodeficiencies of the AS Loginov Moscow Clinical Scientific Center from 2002 to 2019 (data on 2008-2010 are not available). The distribution of patients by sex was approximately equal, median age was 35 years (range 20-74 years). Results. Histological HL variant is predominantly mixedcell with many positive tests for Epstein-Barr virus. More than 80 % of patients with concomitant HIV infection were admitted to the AS Loginov Center with HL stage III/IV. Most of them received highly active anti-retroviral therapy (HAART) before HL diagnosis. The distinguishing feature of HIV-positive patients with HL appeared to be high (as compared to HIV patients with other lymphoma variants) CD4+ lymphocyte count. This phenomenon is considered within the framework of immune reconstitution inflammatory syndrome (IRIS). A clue to this phenomenon may lay the foundation in addressing the issue of lymphoma genesis and development. Viral load was moderate and undetectable. Hepatitis C and/or B co-infection was identified in 95 % of patients. Antiviral therapy for concomitant hepatitis C was administered concurrent with HAART. All patients received АBVD, BEACOPP-14, BEACOPP-escalat-ed, DHAP, ESHAP antitumor regimens. Radiotherapy was used if necessary. In hepatitis C HAART and direct-acting drugs were administered concurrent with chemotherapy. No severe adverse reactions were observed. Even before starting antitumor treatment of HL patients with concomitant HIV and/or hepatitis viral infections, mortality was 8 %. But in the group of patients with the same co-infections who received HL chemotherapy, mortality was 10 %. The cause of death was HL stage IVB with viral liver cirrhosis, agranulocytosis, and sepsis. Conclusion. Diseases considered incurable in the past, such as HL and hepatitis C, can be healed today. Compromised immunity of HIV-positive patients can be successfully stabilized with HAART.