Infection with the human immunodeficiency virus (HIV) leads to selective depletion of the helper/inducer lymphocyte subset and a subsequent state of acquired cellular immunodeficiency. Simultaneously, evidence of B-cell hyper-activity may exist. A subset of patients infected with HIV demonstrates a syndrome of persistent generalized
lymphadenopathy (PGL). Lymph node biopsies reveal benign reactive changes with a pattern of florid follicular
hyperplasia. A polyclonal
hypergammaglobulinemia reflects humoral immune dysfunction. Patients with PGL are similar to those with full-blown
AIDS with regards to demographics, immune and virologic studies. Our prospective natural history study of PGL patients initiated in November 1981 reveals a 15% rate of evolution to
AIDS in the 200 patient cohort. Factors associated with increased risk of transformation to
AIDS include severity of constitutional symptoms, shrinking
adenopathy,
oral candidiasis or viral
hairy leukoplakia, peripheral
cytopenias, elevated erythrocyte sedimentation rate or an antecedent episode of
herpes zoster. Therapeutic interventions to prevent evolution to
AIDS in high risk subsets of
lymphadenopathy patients have been investigated. In addition to benign B-cell proliferation associated with
HIV infection,
malignant lymphomas have also been diagnosed in 29 patients in
AIDS risk groups in our clinic population. All patients were male; 26 homosexuals, 2 IV drug abusers and 1 multiply transfused
sickle cell anemia patient. Seven patients had antecedent PGL.
Non-Hodgkin's lymphoma was diagnosed in 19 patients. Histologies were predominantly diffuse undifferentiated or large cell. Eleven patients were Stage IV at diagnosis. Of 10 patients with mixed cellularity
Hodgkin's disease, 7 were Stage IV-B at presentation. Extranodal disease was frequent in patients with
lymphomas. Fourteen patients lacked peripheral
lymphadenopathy. Response to
chemotherapy was good, but complicated by prolonged marrow suppression and development of
AIDS-related opportunistic infections. Median survival was 7 months. Laboratory studies investigating the possible role of lymphotropic retroviruses in the development of
AIDS-related lymphomas revealed that serum from all patients with high grade
non-Hodgkin's lymphoma contained
antibodies to HIV and that the majority also expressed
antibodies to HTLV-I. This degree of seroreactivity to HTLV-I and HIV was characteristic only of
lymphoma patients as sera from only 10 - 15% of
AIDS and
ARC patients in San Francisco had similar findings.