Second International Congress Drug Therapy in HIV Infection 18-22 November 1994 Glasgow, UK

EPIDEMIOLOGICAL VIROLOGICAL AND CLINICO-PATHOLOGICAL DATA FROM 114 PATIENTS (PTS) WITH HODGKIN'S DISEASE AND HIV INFECTION (HD-HIV): EVIDENCE OF SIGNIFICANT RELATION TO EPSTEIN-BARR VIRUS (EBV), INCREASE OF MIXED CELLULARUTY (MC) AND LYMPHOCYTE DEPLETION (LD) SUBTYPES AND FEASIBILITY OF COMBINED TREATMENT WITH CHEMOTHERAPY(CT) AND ZIDOVUDINE

D. Errante, U. Tirelli, D. Serraino, M. Boiocchi, A. Carbone
For the GICAT (Italian Cooperative Study Group on AIDS and Tumors), C.R.O. Aviano - Italy.

Int Cong Drug Therapy HIV 1994 Nov 18-22;2:Abstract No. 10.3
AIDS 1994, Vol. 8 (Suppl. 4);S9

Since November 1986, 114 cases (103 m, 11 f) of HD-HIV have been collected by the GICAT. The median age was 29 years (19-57), 80% were IVDU 10 accordance to the overall epidemiology of HIV infection in Italy. At the diagnosis of HD, 17% of pts had AIDS, 22% ARC, 29% POL and 34% wore asymptomatic; median CD4+ cell count was 275/mm³ (9-1100). Lymphocyte predominance (LP) was observed in 4%, nodular sclerosis (NS) in 30%, MC in 44% and LD in 21% of pts. In comparison with 125 Italian HD pts not infected with HIV, observed in the same period of time at our Institution and with a comparable median age, a 4-fold higher frequency of the MC and an approximately 12-fold higher frequency of the LD subtypes were detected among pts with HD-HIV.

To determine whether EBV may playa role in HD-HIV we characterized EBV (latent membrane protein, LMP-l) In HD samples from 18 pts with HD. HIV as well as from a control population of 104 pts with HD. EBV was detected in 14/18 (78%) HD samples from the former group, but only in 27/104 (25%) HD samples from the latter group (p < 0.00 1) Indicating that EBV may be more pathogenetically invoived In HD-HIV, as previously reported for HIV-assoctated NHLs.

Thirty-one/108 (28%) and 56/108 (51%) pts were stage III and IV respectively: 78% of pts had B symptoms. These figures wore significantly different from those observed in pts with HD of the general population. Twelve pts received no treatment, 7 pts radiotherpy (RT] alone. 53 pts were treated with standard CT (MOPP, MOPP-/ ABVD ± RT] and obtained 45% complete remission (CR) and 34% partial remission (PR). Twenty six pts were treated prospectively with EBV ± P (Epirubicin, Bleomycin, Vinblastine ± Prednisone) + AZT ± G-CSF and obtained 58% CR and 27% PR.

The median survival of all pts was 15.3 months. Pts with CD4 + lymphocytes ≤ 250/mm³ at onset of HD had a median survival of 11.5 months, while those with CD4+ > 250/mm³ a median of 38 months (p=0.002). The median survival of pts without and with AIDS at onset of HD was 27 months and 9 months respectively (p < 0.001) and for pts achieving or not CR was 58 months and 11 months respectively (p < 0.001). Pts without B symptoms survived sIgnificantly longer than pts with B symptoms (43 vs 12 months, P < 0.001). Age more or less than 30 years, sex, risk group (IVDU vs other groups), stage (I + II vs III + VI, extranodal involvement, were not factors infiuencing survival. The median survival of 26 pts treated with EBV ± P + AZT ± G-CFS was not different (13 months) from that of pts treated with standard CT (17 months) but a statistically significant lower rate of opportunistic infections (OI) occurred in the first group (32% vs 74%. p=0.003) during or after treatment. In conclusion, in comparison to HIV-negative HD there is evidence of a significant increase of: 1) MC and LD subtypes, 2) EBV expression in tumor tissue. Moreover, there is evidence of feasibility of antiretroviral therapy and CT with a significant reduction of OI.

Supported by grants of AIRC.

Presenting author: D. Errante

1994-11-18
10.3

Originally published in AIDS Volume 8, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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