Prostate Cancer in HIV-Infected Patients

Abstract

Background: Non-acquired immunodeficiency syndrome-defining malignancies are increasing in human immunodeficiency virus (HIV)-infected patients. In the United States, prostate cancer is the second most common form of cancer and the second leading cause of death in men. In the case of HIV-infected patients, published studies of the prevalence of prostate cancer have produced mixed results. Methods: A retrospective study was conducted. A total of 2060 patients with HIV (1361 men and 699 women) were evaluated in the HIV Outpatient Program Clinic based at the Medical Center of Louisiana in New Orleans as of December 2009. Results: A total of 9 patients with prostate cancer who were also infected with HIV were identified. All patients were African American. The mean age was 54.4 years (range, 50-60 years). The mean CD4 count was 404.44 cells per milliliter before treatment and 363 cells per milliliter after treatment. The viral loads ranged from 70 to 260,000 copies per milliliter before the treatment to less than 50 to 400 copies per milliliter after the treatment. The mean prostate specific antigen level was 7.52. The mean number of years of HIV infection was 5.2 years. The mean average of Gleason score was 6.4. Approximately 90% of these patients received treatment. Twenty-two percent (22%) received chemotherapy, 44% received radiotherapy, and 55% had surgery. One patient presented with metastases. All patients were on antiretroviral therapy. Almost half (45%) of them were exposed to protease inhibitors during their HIV treatment regimens; 44% were overweight. Approximately 11% of the patients were exposed to testosterone owing to hypogonadism before cancer prostate diagnosis. Comorbidities (prostatitis, recurrent urinary tract infections, and benign prostate hypertrophy) were present in 33% of the cases. Discussion: Our results concur with some articles reported in the literature. Our patients' conditions were diagnosed at an earlier age (54.4 years) compared to non-HIV-infected populations (70 years). An interesting datum from our study is the average years with HIV infection before prostate cancer diagnosis. Our patients reported an average of 5.2 years, which is shorter compared to other reports' findings. Comorbidities were higher than in other reports. The significance of obesity, aging, testosterone exposure, and use of protease inhibitors in the development of prostate cancer in HIV-positive patients needs to be further studied.