Prevalence of HIV Infection among U.S. Hodgkin Lymphoma Cases

Abstract

Background Hodgkin Lymphoma (HL) is uncommon in the U.S. general population; however, HL risk is elevated in people with human immunodeficiency virus (HIV) infection. Thus, despite the low HIV prevalence in the U.S, the HIV epidemic may have contributed substantially to the general population burden of HL. Methods We used data from 14 U.S. cancer registries in the Surveillance, Epidemiology and End Results Program that recorded HIV status of HL cases at diagnosis during 2000–2010. We computed the HIV prevalence in HL cases by demographic and tumor characteristics, the proportion of deaths among HL cases due to HIV, and 5-year mortality by HIV status. Results Of 22,355 HL cases, 848 (3.79%) were HIV-infected at diagnosis. HIV prevalence in HL cases was greater among males than females (6.0 vs. 1.2%). Among males, HIV prevalence was greatest among 40–59 year-olds (14.2%), non-Hispanic blacks (16.9%), Hispanics (9.9%) and among cases of lymphocyte-depleted (15.1%) and mixed cellularity HL (10.5%). Eight percent of male and 1.5% of female HL cases died from HIV. Five-year mortality was two-fold higher in HIV-infected HL cases (36.9 vs. 17.5%). Conclusions In the U.S., a substantial proportion of lymphocyte-depleted and mixed cellularity HL cases and HL cases among non-Hispanic black, Hispanic and middle-aged men are HIV-infected. Additionally, HIV is an important cause of death among HL cases. Impact Clinicians should be aware of the high prevalence of HIV in certain subgroups of HL patients and routine HIV testing should be recommended for all patients presenting with HL.

How I treat classical Hodgkin lymphoma in patients infected with human immunodeficiency virus

“…Excisional biopsy revealed recurrent EBV-positive (EBV 1 ) cHL lymphoma, MC subtype. CD4 1 count was 145 cells per mm 3 and HIV viral load remained undetectable. 18 FDG-PET revealed no extranodal disease ( Figure 2D).…”

“…After 2 cycles, CT showed no disease, and he proceeded to autologous stem cell transplant (auto-SCT) following carmustine, etoposide, cytarabine, and melphalan conditioning. CD4 1 count 3 months posttransplant was 186 cells per mm 3 . The patient has been followed on cART for 7 years with no relapse, undetectable HIV with CD4…”

“…Disclosures The authors, Associate Editor Jacob M. Rowe, and CME questions author Laurie Barclay, freelance writer and reviewer, Medscape, LLC, declare no competing financial interests. was 140 cells per mm 3 . He commenced tenofovir, lamivudine, and ritonavir-boosted atazanavir for HIV, as well as trimethoprim/ sulfamethoxazole for Pneumocystis pneumonia prophylaxis.…”

“…1 count was 173 cells per mm 3 . Twelve months after completing chemotherapy, a new axillary lymph node was palpated.…”

“…3 Unlike HIVassociated NHL (HIV-NHL), in which incidence decreased by 50% after introduction of cART (mainly owing to decreases in immunoblastic histologic types), 5,6 HIV-cHL risk has remained stable and burden of disease has increased. 2,6,7 In the United States, cHL follows NHL, Kaposi sarcoma, lung cancer, and anal cancer as the fifth commonest tumor in the setting of HIV.…”