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Hodgkins and HIV; Will my CD4 counts go up? What's the Likelihood of Relapsing?
Jun 29, 2001

I was diagnosed with Hodgkin's disease in December 2000, stage Ia. As a part of the process to get to the diagnosis, I had an HIV test, which turned out to be positive. Merry Christmas. :) My only symptom was a funny swelling in my neck. I have had 8 treatments of ABVD (which knocked me flat so badly, they had to pull back some on the amounts), and am half way through 20 radiation treatments. I also started on Sustiva and Kaletra and the same time I started chemo. My oncologist and my infectious disease doctor consulted with some doctors in San Francisco to be sure the chemo and HIV drugs would be OK toegther. My viral count was around 15,000, and my CD4 was about 175 when I started.

My viral load went to below 50 in March (after 2 months on the drugs), while still on chemo and the HIV drugs, but my CD4 count went down to about 115. Does chemo do that to the CD4 count? I am going back next week for a checkup, and am praying my CD4 count is higher, now that I have been off chemo for two months. Is that the norm? I have no other symptoms.

Question: Does radiation affect CD4 counts?

Last questions: Is Hodgkin's still considered a non-related cancer to HIV?

What is my chance of relapse? (My scans were totally clean in May).

I am also doing a Pentamadine treatment monthly as a precaution against PCP. I there a pill I can take instead of these treatments? Sorry for the many questions, it' s just that my doctors, while I think good, don't have great bedside manner. Thank you.

Response from Dr. Dezube

You ask many good questions. I'm glad to hear that you successfully completed your treatments. You deserve a big pat on the back.

1) Both chemotherapy and radiation therapy can lower your CD4 counts. In time the CD4 counts will rise, but if often takes much more than 2 months. It can take up to a year. Often the CD4 counts don't quite rise to where they were before treatment. However, the rise in CD4 is usually enough to protect you from all the various AIDS infections.

2) You could certainly take Bactrim for PCP prophylaxis instead of Pentamidine unless there was some reason that Bactrim was no good for you (e.g. if you had an allergy to Bactrim and were not able to be desensitized to it).

3) As for your chance of relapse, your best bet is to be faithful to your anti-viral medications. The longer you can suppress your viral load, the lower your chance of relapse. Obviously no one can give you a 100% guarantee that you Hodgkin's won't come back. I have many former Hodgkin's patients out 5 years of more who are cancer free.

4) As for the relationship between Hodgkin's disease and HIV, Hodgkin's disease is technically not an AIDS-defining cancer. Nevertheless it is quite common in HIV positive patients. Also the type and distribution of the Hodgkin's disease seen in HIV+ patients is fairly different than that seen in HIV- patients.

Good luck!

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