Clinical Presentation Of Hivassociated Hodgkins Lymphoma

HIV-seropositive patients with HD generally present with more advanced-stage disease than do seronegative patients. In the seven reported series, 70-85% of seropositive patients present with Ann Arbor stage III or IV, while less than half of the immunocompetent patients with HD will have stage III/IV disease at presentation.95'96'104-108 Moreover, B symptoms occur in 70-100% of HIV-seropositive patients with HD, although it may be impossible to distinguish the relative contributions of HIV and HD to these symptoms. Extranodal HD also occurs more commonly (up to 70%) than in the HIV-negative population. The bone marrow is the most commonly involved extranodal site affecting 50% of patients; other extranodal sites include skin, liver, and occasionally the CNS. Furthermore, there is a lower incidence of mediastinal involvement in the HIV-seropositive population (13%) compared to the general population with HD (70%).95 The mixed cellularity histologic subtype, which is more common in HIV-positive patients, does not affect the mediastinum as commonly as the other types; nevertheless, the histologic differences do not account for all the difference observed in mediastinal disease.

The median CD4 cell count at diagnosis of HD is between 128 and 306/^L in the published series all of which pre-date the HAART era. This is higher than the median CD4 cell count reported in the pre-HAART era for high-grade NHL. At presentation of HD, 50-90% of patients had been previously diagnosed with HIV, while 4-46% (median 11%) had a prior AIDS-defining diagnosis. Thus HD tends to present at an earlier stage of immunosuppression than NHL, and it is intriguing that HD is not a feature of iatrogenic immunosuppres-sion in allograft transplant recipients, although post-transplant NHL is a well-recognized entity.

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