Abstract
BackgroundThe incidence of AIDS-defining cancers (ADCs) has decreased markedly in the era of highly active antiretroviral therapy (HAART). The occurrence of two ADCs is rare in people living with HIV or AIDS (PWHA) who are severely immunosuppressed or have incomplete virologic suppression.Case presentationWe report a case of dual primary ADCs, especially NHL followed by KS, in a 70-year-old HIV-infected man who was on antiretroviral therapy and had successful virologic suppression. During HAART, he presented with generalized myalgia and abdominal pain. Multiple liver masses were detected and a biopsy revealed Burkitt’s lymphoma. After three cycles of anticancer chemotherapy with a favorable response, he was diagnosed with cytomegalovirus retinitis and the anti-cancer chemotherapy was discontinued. Despite successful virologic suppression with HAART, human herpes virus-8 associated Kaposi’s sarcoma was diagnosed in his right thigh. He underwent radiation therapy.ConclusionThese findings suggest that multiple ADCs can occur in PWHA who are receiving HAART and have successful virologic suppression. Healthcare providers caring for PWHA should maintain vigilance for the development of a broad spectrum of cancers.
Highlights
The incidence of AIDS-defining cancers (ADCs) has decreased markedly in the era of highly active antiretroviral therapy (HAART)
These findings suggest that multiple ADCs can occur in people living with HIV or AIDS (PWHA) who are receiving HAART and have successful virologic suppression
Healthcare providers caring for PWHA should maintain vigilance for the development of a broad spectrum of cancers
Summary
The introduction of highly active antiretroviral therapy (HAART) has changed the natural history of opportunistic infections (OIs) and malignancies among people with HIV or AIDS (PWHA). Case presentation A 70-year-old bisexual man was admitted with generalized myalgia and abdominal pain lasting for 7 days Three months earlier, he was diagnosed with HIV infection during the evaluation of a fever. RNA level was 36,500 copies/mL, with 114 CD4+ lymphocytes/μL, which were consistent with the definition of AIDS [9] the exact timing of HIV infection was unknown. Interim PET/ CT showed a partial response with marked improvement of the lymphomatous involvement in the bone marrow and liver, but hypermetabolic para-aortic, aortocaval lymph nodes remained 3 months after initiating chemotherapy. Four months after discontinuing the chemotherapy, PET/CT showed disease progression in the para-aortic, aortocaval lymph nodes, and newly developed lymphomatous involvement was seen in the paravertebral and cardiophrenic space. Two months after radiation therapy, multiorgan (bone, liver, and pericardium) lymphoma aggravation led to his death
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