Costello R, Heuberger L, Petit N, Olive D, Gastaut J A
Département d'hématologie, université de la Méditerranée, institut Paoli-Calmettes, Marseille, France.
Rev Med Interne. 1998 Aug;19(8):558-64. doi: 10.1016/s0248-8663(99)80023-x.
Hodgkin's disease in patients infected by the human immunodeficiency virus (HIV) is still not part of the definition of acquired immune deficiency syndrome. Nonetheless, this entity has a particular presentation when compared to the disease occurring in immune-competent patients.
Increased frequency (> 75%) of advanced anatomical stages and extranodular localizations (Ann Arbor system stages III and IV) has been outlined in HIV-infected patients. Mediastinal involvement is more unusual in immunocompromised than in immune-competent patients. The presence of B symptoms (fever, weight loss, nocturnal sweats) is very frequent. Finally, the predominance of mixed cellularity (type 3) characterizes Hodgkin's disease in immunocompromised patients. Due to either the immunodeficiency, antiretroviral treatments, poor hematological tolerance in response to chemotherapy, or to advanced anatomical stages, disease management may be hampered. Current therapeutical approaches often obtain complete remission; however, some deaths are still related to the disease progression to acquired immune deficiency syndrome.
From these observations, Hodgkin's disease management in HIV-infected patients relies on therapeutical approaches similar to those used for non infected patients, with some specific recommendations. Chemotherapy should be conducted in the shortest time in order to minimize chemotherapy-induced immunosuppression. Simultaneous use of antiretroviral treatment and reinforced opportunistic infection prophylaxis are of pivotal importance. Finally, the use of hematopoietic growth factors appears to be safe regarding viral replication, but still requires further evaluation.
感染人类免疫缺陷病毒（HIV）的患者中的霍奇金病仍不属于获得性免疫缺陷综合征的定义范畴。尽管如此，与免疫功能正常的患者所患疾病相比，这种疾病有其特殊的表现形式。
已概述HIV感染患者中晚期解剖分期和结外定位（Ann Arbor分期系统的III期和IV期）的频率增加（>75%）。纵隔受累在免疫功能低下患者中比免疫功能正常患者更不常见。B症状（发热、体重减轻、盗汗）的出现非常频繁。最后，混合细胞型（3型）占优势是免疫功能低下患者霍奇金病的特征。由于免疫缺陷、抗逆转录病毒治疗、化疗后血液学耐受性差或解剖分期较晚，疾病管理可能会受到阻碍。目前的治疗方法常常能获得完全缓解；然而，仍有一些死亡与疾病进展为获得性免疫缺陷综合征有关。
基于这些观察结果，HIV感染患者的霍奇金病管理依赖于与非感染患者相似的治疗方法，并给出了一些具体建议。化疗应在最短时间内进行，以尽量减少化疗引起的免疫抑制。同时使用抗逆转录病毒治疗和加强机会性感染预防至关重要。最后，造血生长因子的使用在病毒复制方面似乎是安全的，但仍需要进一步评估。
