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09:54
Chronic, Acute, and Reactivated HIV Infection in Humanized Immunodeficient Mouse Models
Published on: December 3, 2019
Human immunodeficiency and Hodgkin lymphoma.
Gerhard Sissolak1, Dagmar Sissolak, Peter Jacobs
1Division of Clinical Haematology, Department of Internal Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, South Africa.
Summary
Hodgkin lymphoma (HL) in HIV-infected individuals presents aggressively. Combination therapy with antiretroviral treatment (cART) significantly improves survival rates for HL patients.
Area of Science:
- Oncology
- Infectious Diseases
- Virology
Background:
- Hodgkin lymphoma (HL) in HIV-infected individuals often presents with advanced disease, B symptoms, and extranodal involvement.
- HL in this population is associated with specific histopathologic subtypes (mixed-cellularity, lymphocyte-depleted) and gamma-herpesvirus co-expression.
- Prior to combination antiretroviral therapy (cART), median survival for HL was poor (1-2 years).
Purpose of the Study:
- To evaluate the impact of modern chemotherapy regimens combined with cART on survival outcomes for HIV-associated Hodgkin lymphoma.
- To compare the efficacy of different treatment protocols, including ABVD, BEACOPP, and Stanford V, in the context of HIV infection.
- To assess the role of supportive care and bacterial prophylaxis in improving outcomes for HIV-infected HL patients.
Main Methods:
- Retrospective analysis of patients with HIV-associated Hodgkin lymphoma treated with various chemotherapy regimens (ABVD, BEACOPP, Stanford V) and cART.
- Comparison of survival data (overall survival, disease-free survival, freedom from progression) between different treatment groups and historical controls.
- Evaluation of treatment tolerability and toxicities associated with intensive chemotherapy regimens in HIV-infected patients.
Main Results:
- Chemotherapy regimens like BEACOPP and Stanford V, when combined with cART, significantly improved overall survival (OS) compared to older regimens or no cART.
- BEACOPP achieved an 83% OS at 2 years, while Stanford V showed a 51% OS at 3 years, with good disease-free survival (DFS) and freedom from progression (FFP).
- Supportive care, including G-CSF and bacterial prophylaxis, further enhanced outcomes, approaching those seen in HIV-uninfected populations.
Conclusions:
- Combination therapy with cART and intensive chemotherapy regimens (BEACOPP, Stanford V) has dramatically improved outcomes for HIV-associated Hodgkin lymphoma.
- The risk of HL is significantly elevated (5-25 times) in HIV-infected individuals compared to the general population.
- Hodgkin lymphoma should be considered a significant non-AIDS-defining cancer in HIV-infected individuals, warranting further investigation in prospective studies.
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