Abstract
BackgroundChronic human immunodeficiency virus (HIV) infection is associated with an increased incidence of Non-Acquired Immunodeficiency Syndrome (non-AIDS) defining cancers. To date, only a limited number of cases of bladder cancer have been linked with HIV infection. We sought to describe the clinical characteristics of HIV-associated bladder cancer.MethodsA retrospective study was performed involving HIV-positive patients with bladder cancer, combining cases from multiple institutions with published case reports. Data regarding patient demographics, HIV status, clinical presentation, pathology, cancer treatment, and outcome were analyzed using descriptive statistics.ResultsEleven patients were identified with a median age of 55 years (range, 33 - 67). The median CD4+ count at cancer diagnosis was 280 cells/mm3 (range, 106 - 572 cells/mm3). Six patients (55%) had a known risk factor for bladder cancer, and nine (82%) presented with hematuria. Ten patients had transitional cell carcinoma, and most had superficial disease at presentation. Treatment included mainly transurethral resection of bladder tumor followed by a combination of local and systemic therapies. One patient received intravesical bacillus Calmette-Guèrin (BCG) without complication. Several patients (55%) were alive following therapy, although many (64%) suffered from local relapse and metastatic disease.ConclusionBladder cancer is part of the growing list of cancers that may be encountered in patients living longer with chronic HIV-infection. Our patients presented at a younger age and with only mild immunosuppression, however, they experienced an expected course for their bladder cancer. Hematuria in an HIV-infected patient warrants a complete evaluation.
Highlights
Chronic human immunodeficiency virus (HIV) infection is associated with an increased incidence of Non-Acquired Immunodeficiency Syndrome defining cancers
We present the largest series of HIV-associated bladder cancer involving 11 patients
Bladder cancer is part of the growing list of cancers likely to be encountered in HIVinfected patients living longer with controlled HIV disease
Summary
Chronic human immunodeficiency virus (HIV) infection is associated with an increased incidence of Non-Acquired Immunodeficiency Syndrome (non-AIDS) defining cancers. Human immunodeficiency virus (HIV) infection has become a chronic illness for many patients since the advent of highly active antiretroviral therapy (HAART). As their life expectancy increases, patients with chronic HIV infection are developing diseases associated with aging and longer-term exposure to several oncogenic risk factors (e.g. oncovirus coinfection). Epidemiologic studies in the HAART era have demonstrated an increased incidence of Non-AIDS Defining Cancers (NADC) including lung cancer, skin cancer (other than Kaposi sarcoma), anal cancer, hepatocellular carcinoma, conjunctival cancer, Hodgkin lymphoma, plasma cell neoplasia and leiomyosarcoma in HIV-infected patients [1]. While HIV infection may not lead to an increased incidence of all malignancies, it can alter the presentation, natural history and potential therapeutic options available to patients afflicted with these neoplasms
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