%0 Journal Article
%T HIV-Associated Hodgkin's Lymphoma: Prognosis and Therapy in the Era of cART
%A Caron A. Jacobson
%A Jeremy S. Abramson
%J Advances in Hematology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/507257
%X Patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are at increased risk for developing Hodgkin's lymphoma (HL), a risk that has not decreased despite the success of combination antiretroviral therapy (cART) in the modern era. HIV-associated HL (HIV-HL) differs from HL in non-HIV-infected patients in that it is nearly always associated with Epstein-Barr virus (EBV) and more often presents with high-risk features of advanced disease, systemic ¡°B¡± symptoms, and extranodal involvement. Before the introduction of cART, patients with HIV-HL had lower response rates and worse outcomes than non-HIV-infected HL patients treated with conventional chemotherapy. The introduction of cART, however, has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that approach those seen in non-HIV infected patients. Despite these significant advances, HIV-HL patients remain at increased risk for treatment-related toxicities and drug-drug interactions which require careful attention and supportive care to insure the safe administration of therapy. This paper will address the modern diagnosis, risk stratification, and therapy of HIV-associated HL. 1. Introduction Since the introduction of combination antiretroviral therapy (cART) in 1996, patients with human immunodeficiency virus (HIV) infection are living longer, with improved immune function and a reduced risk of developing acquired immune deficiency syndrome (AIDS) [1, 2]. In concert with improved viral control, there has been a substantial change in the landscape of malignancies occurring in the setting of HIV. AIDS-defining cancers such as Kaposi's sarcoma (KS) and non-Hodgkin's lymphomas (NHL) have declined significantly, though the change in NHL incidence has not applied evenly across disease subtypes. Diffuse large B-cell lymphoma, primary CNS lymphoma, plasmablastic lymphoma, and primary effusion lymphoma have all declined, while Burkitt lymphoma has remained stable. Over the same time period, non-AIDS-defining malignancies, including numerous solid tumors and Hodgkin's lymphoma (HL), have remained stable or have increased in incidence [3, 4]. The growth of an aging population with HIV has contributed to this rise, but the risk of many of these cancers remains significantly increased above that observed in the general population, suggesting an effect of ongoing virus-mediated immune suppression and stimulation on cancer risk despite the salutary effects of antiretroviral therapy [3¨C8]. There will be approximately 8800 new cases
%U http://www.hindawi.com/journals/ah/2012/507257/