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how does one prevent this if infected
Nov 8, 2003

Dr. Dave,

How does one prevent this if infected?

Ryan

Hodgkin's Lymphoma as a Cause of Fever of Unknown Origin in HIV Infection

The risk of Hodgkin's lymphoma is increased in HIV-infected patients. In these patients Hodgkin's lymphoma is an aggressive disease with poor clinical outcome. Complete remission and survival rates are far below that reported in HIV-uninfected population.

Since the widespread use of HAART, malignancies are the major cause of mortality in HIV-infected patients.

Doctors at the Hopital Saint-Louis in Paris report a case of a 29-year-old HIV-positive male who presented with fever of unknown origin, pancytopenia, and hemophagocytic syndrome.

The diagnosis of Hogkin's lymphoma with bone marrow involvement was made on bone marrow biopsy, 5 months after the onset of fever.

The patient was treated with chemotherapy and achieved a complete remission.

Relapse occurred 28 months later and he died 31 months after initial diagnosis.

Prolonged fever is frequently observed in HIV-infected patients and could represent a diagnostic challenge. Infectious diseases are the most common causes, however lymphomas are the third most common cause of fever of unknown origin in HIV disease.

This case illustrates the difficulties in accurately diagnosing Hodgkin's lymphoma in patients presenting with prolonged, unexplained fever, and emphasizes the use of bone marrow biopsy to confirm Hodgkin's lymphoma, particularly if cytopenia and hemophagocytic syndrome are present.

11/07/03

Reference L Gerard and E Oksenhendler. Hodgkin's Lymphoma as a Cause of Fever of Unknown Origin in HIV Infection. AIDS Patient Care STDS 17(10): 495-499. October 2003.

Response from Dr. Wohl

People living with HIV/AIDS in resource rich nations where potent HIV therapy is available enjoy increased survival free of opportunistic infections (such as PCP, bacterial and parasitic infections). But, these therapies do not make one immortal. So, people are living long enough to get other diseases including maligancies and liver failure from viral hepatitis. Many malignancies are diminished with HIV therapy, for instance, Kaposi's sarcoma. Lymphomas rates, however, seem not have dropped as much; this may be due to a need for higher levels of immune function to prevent this disease.

The best things that can be done to prevent cancer in HIV+ persons are generally the same as those recommended to everyone: stop smoking, eat a balanced diet that includes fiber, avoid excessive alcohol, etc. In addition, keeping your immune system strong is probably key. The immune system not only protects us from infections but also from cancers.

There are no guarantees, of course, and even people without HIV infection get Hodgkin's lymphoma and other cancers, but effective HIV therapy is the best bet. DW


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