Drs. Tirelli, Serraino, and Carbone report that the MC and LD subtypes of Hodgkin disease are more common among HIV-infected patients than among those without HIV infection. They also observed a significant increase in the proportion of HIV-infected patients who present with advanced stages of disease compared with patients without HIV infection. Findings from seven HIV-infected homosexual men with Hodgkin disease in our cohort study [1] support these observations. Four had an MC histologic subtype, one had an LD subtype, and two had NS subtypes (Table 1). Additionally, four men presented with advanced-stage disease, two with early-stage disease, and one with an unknown disease stage.

Drs. Ames, Metroka, and Goldberg propose that HIV-infected persons with high-grade or advanced-stage Hodgkin disease should be considered to have AIDS but that additional studies are needed before early-stage and low-grade Hodgkin disease in HIV-infected persons is considered to be diagnostic of AIDS. Our data agree; all of our patients with Hodgkin disease presented with either high-grade or advanced-stage disease.

In the proposed expansion of the CDC case definition of AIDS, adults with HIV infection and CD4 + cell counts of less than 200/mm³ would be considered to have AIDS [2]. Therefore, a patient with HIV infection and Hodgkin disease who also has severe immune impairment (CD4+, < 200/mm³) would be considered to have AIDS. However, if the purpose of the AIDS definition is to identify HIV-infected persons with an end-stage condition, then high-grade or advanced-stage Hodgkin disease should be considered for addition to the list of AIDS-defining diseases. Doing so would provide additional information on the impact of HIV infection on the development of Hodgkin disease.