A Case of Undiagnosed HIV Infection in a 57-Year-Old Woman with Multiple Myeloma: Consequences on Chemotherapy Efficiency and Safety. (20th July 2016)

• Record Type: Journal Article
• Authors: Poizot-Martin, I.; Brégigeon, S.; Tamalet, C.; Bouabdallah, R.; Zaegel-Faucher, O.; Obry-Roguet, V.; Ivanova, A.; Cano, C.E.; Solas, C.
• Other Names: Ribera Josep M. Academic Editor.
• Is Part Of: Case reports in oncological medicine. Volume 2016(2016)
• Publication Date: 2016-07-20
• Subjects: Oncology -- Periodicals; Tumors -- Periodicals; Oncology -- Case studies -- Periodicals; Neoplasms; Oncology; Tumors; Electronic journals; Periodicals; Case studies; Periodicals; Case Reports; Fulltext; Internet Resources; Periodicals; 616.994
• DOI: 10.1155/2016/8515218
• Languages: English
• ISSNs: 2090-6706

Abstract

Abstract : Background . Non-AIDS-defining cancers represent a rising health issue among HIV-infected patients. Nevertheless, HIV testing is not systematic during the initial cancer staging. Here, we report a case of HIV infection diagnosed three years after chemotherapy initiation for multiple myeloma. Results . A 57-year-old woman diagnosed with multiple myeloma underwent a first round of chemotherapy by bortezomib/lenalidomide and then with bortezomib/liposomal-doxorubicine/dexamethasone, with partial remission, poor hematological tolerance, and multiple episodes of pneumococcal infection. Allogenic stem cell transplantation was proposed leading to HIV testing, which revealed seropositivity, with an HIV viral load of 5.5 L o g 10 / m L and severe CD4 T cell depletion (24 cells/mm 3 ). Chemotherapy by bendamustin was initiated. Multidisciplinary staff decided the initiation of antiretroviral therapy with tenofovir/emtricitabin/efavirenz and prophylaxis against opportunistic infections. After 34 months, patient achieved complete remission, sustained HIV suppression, and significant CD4 recovery (450 cells/mm 3 ), allowing effective pneumococcal immunization without relapse. Conclusion . Our case illustrates the drawback that ignored HIV infection is still causing to cancer patients receiving chemotherapy and highlights the importance of early HIV testing in oncology. A multidisciplinary approach including oncologists/hematologists, virologists, and pharmacists is recommended in order to avoid drug interactions between chemotherapy and antiretroviral drugs. Moreover, prophylactic medication is recommended in these patients regardless of CD4+ cell count at the initiation of chemotherapy.