HIV and Hodgkin’s lymphoma – a medical dilemma
Dr. Khaw is a Sexual Health Advanced Trainee in her third year of part-time training. She is also a clinical skills lecturer with the Medicine Learning and Teaching Unit, University of Adelaide and examines for the Royal Australian College of General Practitioners and Australian Medical Council, SA, Australia
Viral load was undetectable and CD4 count was 276 (24%). In August 2011, she presented with an unplanned pregnancy at 6 weeks gestation. Unfortunately, a month later, she miscarried at 10 weeks gestation. Early October 2011, she developed fevers, nausea and vomiting and was admitted to a country hospital. She was thought to have a lower respiratory tract infection but did not respond to IV antibiotics. She was transferred to the Royal Adelaide Hospital and was unwell on admission.
A CT scan of her neck, chest and abdomen revealed extensive lymphadenopathy. There were bilateral alveolar infiltrates noted in the CT scan of her chest. A lymph node excision biopsy revealed Hodgkin’s Lymphoma of the nodular sclerosis type. The patient decided to return to the UK for treatment of her lymphoma as her family supports are there. She was referred to the Chelsea and Westminster Hospital.
Staging performed revealed a Stage 3b Hodgkin’s Lymphoma. She was managed with full opportunistic infection prophylaxis using cotrimoxazole, fluconazole, acyclovir and azithromycin. She obtained full remission after six cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) combination chemotherapy but developed painful peripheral neuropathy requiring pergabalin. Toxicity and fertility issues were discussed. The patient is now pregnant again at 28 weeks gestation. An overview of HIV associated Hodgkin’s Lymphoma in the era of cART will be presented.
