Hodgkin Lymphoma in People Living with HIV

Abstract

Despite widespread use of combined antiretroviral therapy (cART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with cART. While the incidence of aggressive forms of non-Hodgkin lymphoma decreased after the advent of cART, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein-Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching that of the general population. In this regard, effective cART during chemotherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug-drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PLWH with HL. In this article the authors review and update the epidemiological, clinical and biological aspects of HL presenting in PLWH with special emphasis on advances in prognosis and the factors that have contributed to it.

Keywords: HIV; antiretroviral therapy; hodgkin lymphoma; prognosis.

Figure 1

Classical Hodgkin Lymphoma, Mixed Cellularity. The lymph node architecture is effaced by a mixed population of lymphocytes, plasma cells, eosinophils, histiocytes and Reed–Sternberg (RS) cells ((A,B), Hematoxilin & eosin, 100× and 400×). RS cells are weakly positive for PAX5 ((C), 200×), and Epstein–Barr encoded RNA (EBERs) can be detected ((D), 200×). CD30 and CD15 are strongly positive in RS cells ((E,F) respectively, 200×).