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• W3140334682 abstract "We read with interest the article by Serraino et al.1 who suggest an association between human immunodeficiency virus (HIV) infection and Hodgkin's disease, with a standardized incidence ratio (SIR) of 37.9 compared with the general population of the same age and gender in Italy. We conducted similar research in the Aquitaine cohort of HIV-infected individuals in southwestern France. After finding an association between HIV infection and malignancies that do not classify for the acquired immunodeficiency syndrome (AIDS) stage (Hodgkin's disease excluded),2 we focused on the incidence of Hodgkin's disease. The Aquitaine cohort is a hospital-based cohort of HIV-infected adults,3 most being prevalent cases (i.e., with no estimated date of contamination or follow-up beginning late after the seroconversion). Between 1985 and 1994, 3897 patients were included, 66% of whom were male. All HIV transmission categories were represented, with 33.5% of the cohort comprised of intravenous drug users, 33.0% of homosexual/bisexual males, 2.0% of subjects reporting both behaviors, 13.7% of heterosexually acquired cases, 6.1% of tainted blood recipients, 1.7% of hemophiliacs, and 10.0% of patients with an unknown HIV transmission category. In 1995-1996 we retrospectively conducted an active surveillance of Hodgkin's disease in the Aquitaine cohort through several sources of information: cohort computerized data base, hospital records, and pathology departments. We defined a case in this study as a new occurrence of histologically proven Hodgkin's disease diagnosed at least 3 months after the diagnosis of HIV. All individuals identified through this research process had their diagnosis verified by a single and experienced pathologist who reviewed the histologic specimens. We computed the SIR and then compared the observed incidence rate of Hodgkin's disease in the cohort with the expected figure, using 1978-1992 data from French cancer registries for a population with the same age and gender distribution. Although the Aquitaine cohort accounted for 13,696 person-years of follow-up, 16 cases of Hodgkin's disease were identified and confirmed histologically (15 males and 1 female). Eight only verified the time criteria defined earlier and were used for statistical analysis. All the patients were male; four were intravenous drug users, two were homosexual/bisexual and two were tainted blood recipients. In the Aquitaine cohort, the incidence rate of Hodgkin's disease was 58.5 per 100,000 person-years of follow-up (95% confidence interval [CI], 17.9-98.9). The SIR for both genders combined was 12.6 (95% CI, 5.4-24.8). For males only, the SIR was 17.4 (95% CI, 7.5-34.4). Using all the available cases (n = 16), the SIR would have been 25 overall and 33 for males. Clinicopathologic findings were as follows. Ten of the 16 cases (62.5%) were of the mixed cellularity subtype. In 12 of 15 cases investigated (80.0%), the presence of the Epstein-Barr virus was confirmed. Nine of the 16 cases (56.2%) were diagnosed at asymptomatic Stage B or C of the Centers for Disease Control (CDC) classification of HIV infection,4 with a median CD4+ lymphocyte count of 195/mm3 (range, 20-500/mm3). The same results were obtained when restricting the description to the eight incident cases. The median survival time was 18 months and death generally was attributed to the occurrence of an opportunistic infection or to complications of treatment of the neoplasia rather than to Hodgkin's disease per se. Our findings are in close agreement with those reported by Serraino et al.1 We used stringent time criteria to select cases of Hodgkin's disease in HIV infected subjects. This improved the study of the temporal relationship between these two conditions in the absence of precise dates of HIV contamination and minimized selection bias. We did not computerize a SIR for individual HIV transmission categories because a proper reference population was not available. However, it is unclear whether homosexuals have a higher risk of Hodgkin's disease than males who were infected with HIV through other sources. This study confirmed in a large cohort of both genders and all HIV transmission categories an association between Hodgkin's disease and HIV infection, the specificities of this condition, and its poor prognosis in such a population. We agree with Serraino et al. that Hodgkin's disease should be considered a candidate for an AIDS-defining illness in a future revision of the CDC classification, although it may not drastically change the AIDS statistics. Active surveillance of Hodkin's disease should be implemented to confirm these findings as suggested recently during the U.S. National AIDS Malignancy Conference5 and in the context of an evolving HIV epidemic with better overall prognosis with combination therapies.6 Special thanks to M. Dupon, M.D., J-L. Pellegrin, M.D., and H. Eghbali, M.D. for their help in conducting the study and to L. Dequae-Merchadou, M.Sc. for data analysis. Denis Lacoste M.D.*, Francois Dabis M.D. Ph.D. , Nathalie Boulogne M.D. M.P.H. , Eric Labouyrie M.D. , Jean-Philippe Merlio M.D. Ph.D.?" @default.
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• W3140334682 date "1998-03-01" @default.
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• W3140334682 title "Cancer incidence in a cohort of human immunodeficiency virus seroconverters" @default.
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• W3140334682 doi "https://doi.org/10.1002/(sici)1097-0142(19980301)82:5<996::aid-cncr33>3.0.co;2-u" @default.
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