Hodgkin's disease in AIDS complex patients. Report of four cases and tissue immunologic marker studies

Hodgkin's disease developed in four homosexual men with prodromal manifestations associated with the Acquired Immune Deficiency Syndrome (AIDS) (generalized lymphadenopathy in three and persistent diarrhea, fever, and weight loss in one). All had inversion of the peripheral blood helper-to-suppressor T-cell ratio. The presentations with Hodgkin's disease were atypical with advanced disease (Stage IIIB or IV) in three of four patients and marrow involvement at diagnosis in two. Response to therapy was poor. Immunopathologic studies on the Hodgkin's disease tissue were performed in two patients. In contrast to Hodgkin's disease in non-AIDS risk patients, the Hodgkin's disease tissue in these patients demonstrated severe depletion of helper T-lymphocytes with a predominance of suppressor cells (tissue helper-to-suppressor cell ratio of 0.19 and 0.33, respectively, on immunoperoxidase-stained preparations). In contrast, in five cases of Hodgkin's disease from non-AIDS risk individuals, the lymphocytes population consisted predominantly of helper T-lymphocytes (median tissue helper-to-suppressor cell ratio 3.15, range 2.12-7.77). Homosexual men with AIDS risk factors are at risk for the development of Hodgkin's disease. Hodgkin's disease in these patients may be atypical with severe depletion of helper T-lymphocytes and a predominance of suppressor cells. The lack of an appropriate T-cell immunologic response may contribute to the poor prognosis observed in these patients.