Hodgkin Lymphoma in HIV-Positive Patients: Prognostic Factors and Treatment Strategies

Introduction/Background/Significance: A 42-year-old male presented with malaise, fatigue, generalized lymphadenopathy, and splenomegaly. Lymph node biopsy confirmed a diagnosis of Hodgkin lymphoma, mixed cellularity subtype. During initial evaluation, the patient also tested positive for HIV. Combined treatment for both conditions was recommended; however, the patient opted to initiate chemotherapy abroad. He received the first cycle of ABVD without concurrent antiretroviral therapy, due to the clinic's unawareness of his HIV status. Shortly thereafter, he returned in a severely immunocompromised state, with febrile neutropenia. He was promptly referred to an infectious disease clinic, where antiretroviral therapy was initiated. Once stabilized, the second cycle of ABVD was administered. Despite some clinical improvement, a PET-CT after two cycles showed no disease regression. Treatment was escalated to the BEACOPP-14 protocol, administered alongside continued antiviral therapy. PET-CT after two cycles of BEACOPP-14 showed significant disease regression, and a complete remission was confirmed after four cycles. The patient remains in remission and is under close follow-up by both hematology and infectious disease teams, continuing antiretroviral therapy and regular monitoring.

Materials and Methods/Case Presentation/Objective: The main aim is the highlight the importance of early and integrated management of HIV and Hodgkin lymphoma, emphasizing timely initiation of antiretroviral therapy alongside chemotherapy to optimize immune recovery, improve treatment response, and achieve remission.

A detailed clinical case review was conducted, including analysis of diagnostic findings (lymph node biopsy, PET-CT imaging), treatment protocols (ABVD, BEACOPP-14), antiretroviral therapy initiation, and clinical outcomes. Patient progress was monitored through clinical assessments, laboratory tests, and sequential PET-CT scans, with multidisciplinary management involving hematology and infectious disease specialists.

Results/Description/Main Outcome Measures: The patient initially received ABVD chemotherapy without antiretroviral therapy, resulting in febrile neutropenia and no disease regression. After starting antiretroviral therapy, treatment was escalated to BEACOPP-14. PET-CT after two cycles showed marked regression, and complete remission was confirmed after four cycles. The patient remains in remission under multidisciplinary follow-up.

Conclusions: This case highlights the critical importance of integrated management in HIV-positive patients with Hodgkin lymphoma. The lack of initial coordination between oncologic and infectious care led to severe complications. However, once treated with a multidisciplinary approach—combining BEACOPP-14 chemotherapy and antiretroviral therapy—the patient achieved full remission. This underscores the need for routine HIV screening prior to initiating lymphoma treatment and for close collaboration between specialties to optimize outcomes.

References

•Mochrane Database SystRev, 20042/ D006,14 erventions for treating AIDS associated Hodgkins lymphoma in treatment-naive adults:

• Jacobson CA, Abramson JS, HIV-associated Hodgkin's lymphoma: Prognosis and therapy in the era of cART: Adv Hematol, 2012; 2012; 507257

Prigestic pact on Adan Cedatist Ho Kin LorenoMa. MaDS 201 5:31:1445-1449 doi: 10.1097Q.00000000000148. ionHas

Emetic Ioogle Scholaned-Stage Hodgkin Lymphoma. Al

R2, Outaneo C, Rossi G, HIV and Lymphoma: From epidemiology to clinical management: Mediterr J Hematol Infect Dis, 2019; 11(1);

•Kimani SM, Painschab MS, Horner MI, Epidemiology of haematological malignancies in people living with HIV: Lancet HIV, 2020; 7(9); e641-