LETTER
Hodgkin Disease and HIV
Elizabeth D. Ames;
Craig E. Metroka; and
Arthur F. Goldberg
15 February 1993 | Volume 118 Issue 4 | Pages 313-314
TO THE EDITOR:
We read with interest the recent article by Hessol and colleagues [1], showing an increased incidence of Hodgkin disease in human immunodeficiency virus (HIV)-positive homosexual men in the San Francisco Bay area. If confirmed by other studies, this would indicate that HIV infection can predispose to the development of Hodgkin disease.
Although all of the diseases that currently define the acquired immunodeficiency syndrome (AIDS) are seen with increased frequency in HIV-infected patients, we do not agree that an increased incidence of an illness is necessary to conclude that the disease is related to AIDS. As currently defined, AIDS is not a disease but a syndrome of HIV infection complicated by one or more other infections or neoplasms that indicate that the affected patient is severely immunocompromised and will have a shortened life span. In a review of 50 patients with Hodgkin disease and risk factors for AIDS [2], we showed that such patients have a clinical course and survival after the onset of Hodgkin disease that closely parallel that of persons meeting the Centers for Disease Control definition of AIDS (only 5 of 50 had a previous diagnosis of AIDS).
We therefore recommend that all patients with Hodgkin disease be tested for HIV, especially if they fall into a risk group or if they come from an area with a high prevalence of AIDS. We further propose that HIV-positive persons with high-grade or advanced-stage Hodgkin disease should be considered to have AIDS. Because we do not yet understand the etiology of Hodgkin disease, nor whether the different subtypes comprise a single entity, additional studies are needed to determine if early-stage and low-grade Hodgkin disease are markers for severe immune impairment in HIV-positive persons. Finally, rather than change the expanding list of AIDS-defining illnesses, we suggest that it would be more logical to define AIDS as HIV infection, as shown by positive serologic tests, and then to stage the disease in a manner similar to the Walter Reed staging classification [3], incorporating new diseases or biologic parameters into the staging as our understanding of this illness evolves.
1. Hessol NA, Katz MH, Liu JY, Buchbinder SP, Rubino CJ, Holmberg SD. Increased incidence of Hodgkin disease in homosexual men with HIV infection. Ann Intern Med. 1992; 117:309-11.
2. Ames ED, Conjalka MS, Goldberg AF, Hirschmen R, Jain S, Distenfeld A, et al. Hodgkin's disease and AIDS. Twenty-three new cases and a review of the literature. In: Mitsuyasu RT, Golde DW; eds. Hematology/Oncology Clinics of North America. Philadelphia: WB Saunders, 1991:343-56.
3. Redfield RR, Wright DC, Tramont EC. The Walter Reed staging classification for HTLV 111/LAV infection. N Engl J Med. 1986; 314: 131-2.
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