Choriocarcinoma and human immunodeficiency virus (HIV) infection: A case report

2003

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The appropriate management of gynecological malignancies in association with human immunodeficiency virus (HIV) infection is not established. To date the reported literature on the subject consists mainly of case reports. Due to the increasing prevalence of HIV infection, especially in sub-Saharan countries, the chances of finding both conditions in the same patient has produced management and ethical dilemmas. This retrospective study describes the management of 12 HIV-infected patients and compares their outcome with 29 non HIV-infected patients. The mean age of the non HIV-infected patients was 30 years (range 16-56 years), while the mean age of the HIV-infected patients was 32 years (range 20-47 years). In terms of risk factors, there were 72% of non HIV-infected women in the high-risk category compared to 50% of HIV-infected women (P = 0.468). All patients who received treatment had CD4 counts greater than 200 cells/microl. Two HIV-infected women who did not receive any form of chemotherapy due to low CD4 counts (41 cells/microl and 84 cells/microl) demised of their disease. The majority of women (86% non HIV-infected & 90% HIV-infected) received lfewer than 10 cycles of chemotherapy to attain cure. Most side effects were minor. None of the HIV-infected patients who received chemotherapy demised of their disease. In total, irrespective of risk category, there were 38 patients (93%) who were cured of their disease by chemotherapy including 10 HIV-positive patients. All patients were alive and free of disease at their last follow-up visit. Although the numbers are small, it is proposed that HIV-infected patients with choriocarcinoma and a reasonable degree of CD4 counts (>200cells/microl) should receive standard therapy.

mentioning

confidence: 98%

“…To date the reported literature consists mainly of case reports describing management of such patients (1)(2)(3)(4) . Since the management of malignant gestational trophoblastic disease (GTD) is primarily cytotoxic chemotherapy, the use of such agents presents a management dilemma in HIV-positive patients with varying degrees of immunosuppression.…”

mentioning

confidence: 99%

Gestational trophoblastic syndrome and human immunodeficiency virus (HIV) infection: A retrospective analysis

Moodley¹,

2003

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“…However, the combination of HIV infection and GTD is uncommon, making such trials difficult. Various case reports have documented the occurrence of gynecological malignancies, including GTD, in association with HIV infection (1)(2)(3)(4) . One such report included the successful management of choriocarcinoma in a patient with HIV infection and normal CD 4 count (1) .…”

mentioning

confidence: 99%

“…Various case reports have documented the occurrence of gynecological malignancies, including GTD, in association with HIV infection (1)(2)(3)(4) . One such report included the successful management of choriocarcinoma in a patient with HIV infection and normal CD 4 count (1) . The use of anti-retroviral therapy to boost immunity in HIVinfected patients with low CD 4 counts to acceptable levels prior to commencement of cytotoxic chemotherapy has not been described.…”

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confidence: 99%

Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: A case report

Moodley¹,

2003

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Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD4 counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD4 count. She was given antiretroviral therapy and once the CD4 count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum βHCG level and CD4 count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.

“…However, the combination of HIV infection and GTD is uncommon, making such trials difficult. Various case reports have documented the occurrence of gynecological malignancies, including GTD, in association with HIV infection ( 1–4 ) . One such report included the successful management of choriocarcinoma in a patient with HIV infection and normal CD 4 count ( 1 ) .…”

mentioning

confidence: 99%

Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: A case report

Moodley¹,

2003

Self Cite

Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD4 counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD4 count. She was given antiretroviral therapy and once the CD4 count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum betaHCG level and CD4 count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.