Winston Frederick

Malignancies in HIV: Pre- and Post-Highly Active Antiretroviral Therapy

OBJECTIVES A study was conducted at a large metropolitan tertiary-care teaching hospital to investigate the incidence of cancers among HIV-infected patients over a 13-year period. DESIGN Retrospective cohort study. METHODS A retrospective cohort study was conducted among HIV-infected patients diagnosed with cancer between January 1990 and December 2003 at a large metropolitan teaching hospital. Any HIV-infected patient who also had a confirmed diagnosis of Kaposis sarcoma, primary central nervous system lymphoma, invasive cervical cancer or non-Hodgkins lymphoma was categorized as having AIDS-defining cancer (ADC) according to the CDCs initial case definition for AIDS, while patients with other malignancies were classified as having non-ADCs. A clinical database was created consisting of HIV patients diagnosed with cancer at this teaching hospital, and data were abstracted for the current project. RESULTS A total of 203 HIV-infected patients diagnosed with cancer were identified during the study period. Ninety-three cases occurred before 1995 and 110 after 1996. The median age of patients (at cancer diagnosis) in the era before highly active antiretroviral therapy (HAART) was 37 years and in the post-HAART era was 43 years (p<0.05). Mean CD4 count at cancer diagnosis in the pre-HAART era was 101 cells/mm3, and 183 cells/mm3 in the post-HAART period (p<0.05). Six patients had diagnoses of both ADC and NADC during the study period. Of the 197 remaining cases, 129 (65.4%) were ADCs and 68 (34.6%) were NADCs (p<0.05). The incidence of Kaposis sarcoma decreased significantly, while the incidence of lung cancer increased significantly. CONCLUSIONS Of 197 patients with a single diagnosis of either ADC or NADC, there was statistically a larger proportion of NADC cases diagnosed in the post-HAART period compared to the pre-HAART period. The number of ADC diagnoses decreased between the pre- and post-HAART period.

Testicular plasmacytoma in a patient with the acquired immunodeficiency syndrome

Clinical, laboratory, and pathologic findings from a case of primary extramedullary plasmacytoma of the testis and sinuses in a patient with acquired immunodeficiency syndrome (AIDS) are presented. To our knowledge this is the first case in the English literature of a primary testicular plasmacytoma in an HIV-infected patient. The findings in this report and those of others confirm the difference in the pattern of plasma cell tumor (PCT) presentation in patients infected with AIDS from those in non-infected individuals, suggesting that these tumors should be considered in the differential diagnosis of AIDS-associated malignancies.

Pneumococcal bacteremia in adults: differences between patients with and without human immunodeficiency virus infection

Abstract Objective: To determine the differences between human immunodeficiency virus (HIV)-infected and non-HIV-infected patients with pneumococcal bacteremia. Methods: The demographics, clinical findings, and hospital course of 194 adult cases of pneumococcal bacteremia were retrospectively reviewed. Results: All but six patients were African-American and 41 had HIV infection. The HIV-infected patients were younger (37 vs. 51 years, P Conclusions: The overall hospital course of HIV-infected patients with pneumococcal bacteremia is similar to that of non-HIV-infected patients, despite some clinical differences.