Recurrent Urothelial Bladder Cancer Among HIV-Infected Patients
We report 4 cases of bladder cancer in an ethnically diverse population of about 2500 HIV-infected patients. These patients were younger than the median age at diagnosis of bladder cancer in the United States.
Since the introduction of highly active antiretroviral therapy, the incidence of AIDS-related malignancies, such as Kaposi sarcoma, non-Hodgkin lymphoma, primary brain lymphoma, and cervical cancer, has decreased.1 However, the incidence of non–AIDS-defining cancers, including cancer of the lungs, breast, prostate, skin, colon, and rectum, has increased.2
In HIV-infected persons, urinary bladder cancer is rare; it has been reported in only 13 HIV-infected patients in Europe.3 Gaughan and colleagues4 identified 11 patients with HIV-associated bladder cancer, 7 of whom received highly active antiretroviral therapy; the median age was 58 years, and the male to female ratio was 6:1. Pathology findings at initial diagnosis ranged from low- to high-grade carcinoma. The mean CD4+ cell count was 367/μL (range, 228/μL to 572/μL) for the 7 patients.
We report on 4 cases of urothelial carcinoma of the bladder in ethnically diverse HIV-infected patients at an urban HIV outpatient clinic.
THE CASESCase 1
In 2002, HIV infection was diagnosed in a 65-year-old white woman with a CD4+ cell count of 300/μL and an HIV RNA level of 40,050 copies/mL. She was given zidovudine/lamivudine and nevirapine and had a good response. After 6 months of therapy, laboratory testing revealed a CD4+ cell count of 433/μL and an undetectable viral load.
Figure 1. Ultrasonography detected multiple polypoid masses in the bladder of a 65-year-old HIV-infected woman. The largest mass measured 2.4 × 2.1 × 2.9 cm. Pathological examination revealed that a low-grade urothelial carcinoma had invaded the submucosa.
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