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What's my future as a Hodgkin's disease survivor?
May 3, 2002

I had Hodgkin's, and I was diagnosed with HIV at the same time (Dec. 2000). I had chemotherapy and radiation. When I started, my VL was 15,000 and my CD4 cells were less than 100. I beat the Hodgkin's! I have been done with treatment since last August, My VL is still undetectable (with HIV drugs), and my CD4 cells are 157. Will this improve?

Response from Dr. Dezube

Congratulations on beating the Hodgkin's disease! Your future should be bright. Both Hodgkin's disease and the chemotherapy used to treat it can cause suppression of the immune system and the lowering of CD4 cells above and beyond that caused by HIV infection. The good news is that over time (6 months to a few years) your CD4 count should rise, especially if your viral load remains undetectable. The younger you are the quicker the CD4 count will recover (so the CD4 counts of 20 year olds recover quicker than those of 40 year olds which, in turn, recover quicker than those of 60 years olds). This is because an organ called the thymus is more active in younger folks. It is critically important that you remain on something (e.g. Bactrim) to prevent Pneumocystis Carinii pneumonia (PCP) until your CD4 count is over 200 or until you are 6 months out from chemotherapy, whichever comes LATER. I keep my patients on Bactrim, even if their CD4 counts are above 200, for the first six months after chemotherapy. I do this because of the immunosuppression which can be caused by Hodgkin's disease and by chemotherapy.

While I'm on the subject, HIV patients, who have had Hodgkin's disease, are particularly prone to lung cancer, melanoma, and anal cancer. It is therefore important that HIV-Hodgkin's survivors do everything humanly possible to stop smoking if they smoke, avoid direct sun, and have anal PAP smears if they have ever received anal sex.

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