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Hodgkin Lymphoma in People Living with HIV
Jose-Tomas Navarro1,2,3, José Moltó3,4, Gustavo Tapia3,5
1Department of Hematology, Institute Català d'Oncologia-Germans Trias i Pujol Hospital, Carretera de Canyet s/n, 08916 Barcelona, Spain.
Insights
Hodgkin lymphoma (HL) incidence has risen in people living with HIV (PLWH) despite combined antiretroviral therapy (cART). Effective cART during chemotherapy improves survival for PLWH with HL, necessitating collaborative care.
Area of Science:
- Oncology
- Infectious Diseases
- Virology
Background:
- HIV-related lymphomas (HRL) remain a significant cause of morbidity and mortality in people living with HIV (PLWH).
- While aggressive non-Hodgkin lymphoma incidence decreased with combined antiretroviral therapy (cART), Hodgkin lymphoma (HL) incidence has increased in PLWH.
- Epstein-Barr virus coinfection is critical in the pathogenesis of HL within the HIV setting.
Purpose of the Study:
- To review and update epidemiological, clinical, and biological aspects of HL in PLWH.
- To emphasize advances in prognosis and contributing factors for HL in PLWH.
- To highlight the importance of cART and interdisciplinary care in managing HL in PLWH.
Main Methods:
- Literature review and synthesis of current data on HL in PLWH.
- Analysis of epidemiological trends, clinical presentations, and biological mechanisms.
- Evaluation of treatment strategies, including cART and chemotherapy, and their impact on prognosis.
Main Results:
- The prognosis for HL in PLWH is improving and nearing that of the general population.
- Effective cART during chemotherapy is associated with improved survival rates for all lymphoma subtypes, including HL.
- Interdisciplinary collaboration is crucial for managing drug interactions and toxicities.
Conclusions:
- HL in PLWH requires specialized, collaborative management integrating HIV and hemato-oncology expertise.
- Advances in cART and chemotherapy have significantly improved outcomes for PLWH with HL.
- Continued research into the pathogenesis and treatment of HL in PLWH is essential.
Abstract:
Despite widespread use of combined antiretroviral therapy (cART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with cART. While the incidence of aggressive forms of non-Hodgkin lymphoma decreased after the advent of cART, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein-Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching that of the general population. In this regard, effective cART during chemotherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug-drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PLWH with HL. In this article the authors review and update the epidemiological, clinical and biological aspects of HL presenting in PLWH with special emphasis on advances in prognosis and the factors that have contributed to it.
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