Abstract
Introduction
Co-morbidities introduce confounding variables into investigational protocols and complicate both diagnosis and management of children with malignant solid tumours. Such patients who are coincidentally HIV infected and who also have pulmonary or abdominal tuberculosis pose a particular challenge.
Aim
The purpose of this report is to describe the diagnostic and management difficulties encountered in a small cadre of 18 HIV-infected children with solid tumours presenting to the Department of Paediatric Surgery.
Method
A retrospective descriptive study of HIV-infected children with malignant solid tumours.
Results
18 HIV-infected children were identified with a variety of primary tumours. 11 children had confirmed pulmonary or abdominal tuberculosis and in 4 the diagnosis was suspected. Neoadjuvant chemotherapy was used when possible to provide a window of opportunity to investigate co-morbidity and improve health status, inter alia, improving the patients’ nutritional status. FDG-PET scanning proved unreliable in discriminating between malignant and inflammatory pathology. Overall survival was 33%.
Conclusion
The coincidence of malignancy, HIV infection and tuberculosis carries a high mortality independent of the primary tumour type.
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References
de Cock KM, Mbori-Ngacha D, Marum E (2002) Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century. Lancet 360(9326):67–72
Weitz T, Hosegood V, Jaffar S, Batzing-Feigenbaum J, Herbst K, Newell M (2007) Continued very high prevalence of HIV infection in rural KwaZulu-Natal, South Africa: a population based longitudinal study. AIDS 21(11):1467–1472
Sitas H, Pacella-Norman R, Carrara H, Patel M, Ruff P, Sur R et al (2000) The spectrum of HIV-1 related cancers in South Africa. Int J Cancer 88(3):489–492
Lazzi S, Ferrari F, Nyongo A, Palummo N, de Milito A, Zazzi M et al (1999) HIV-associated malignant lymphoma in Kenya (equatorial Africa). Hum Pathol 30(10):1269–1270
Gandhi NR, Moll A, Sturm AW, Pawinski R, Govender T, Lalloo U et al (2006) Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet 368(9547):1575–1580
Michailidis C, Pozniak AL, Mandalia S, Basnayake S, Nelson MR, Gazzard BC (2005) Clinical characteristics of IRIS syndrome in patients with HIV and tuberculosis. Antivir Ther 10:417–422
Dhasmana DJ, Dheda K, Ravn P, Wilkinson RJ, Meintjies G (2008) Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy: pathogenesis, clinical manifestations and management. Drugs 68(2):191–208
Keou FX, Bélec L, Esunge PM, Cancre N, Gresenguet G (1992) World Health Organization clinical case definition for AIDS in Africa: an analysis of evaluations. East Afr Med J 69(10):550–553
Hellwig D, Graeter TP, Ukena D, Groeschel A et al (2007) 18F-FDG PET for mediastinal staging of lung cancer: which SUV threshold makes sense? J Nucl Med 48(11):1761–1766
Hadley GP, Jacobs C (1990) Clinical presentation of Wilms tumour in black children. South Afr Med J 77:565–567
Friedland G, Harries A, Coetzee D (2007) Implementation issues in tuberculosis/HIV program collaboration and integration: 3 case studies. J Infect Dis 196(Suppl 1):S114–S123
Abdallah FK, Macharia WM (2001) Clinical presentation and outcome in children with nephroblastoma in Kenya. East Afr Med J 78(7):S43–S47
Usmani GN (2001) Pediatric Oncology in the third world. Curr Opin Pediatr 13(1):1–9
Obma M-TA (1996) Pediatric hematology and oncology in Cameroon, Africa: past and future perspectives. Pediatr Hematol Oncol 13(4):315–317
Lameris W, Wilde JCH, van Hasselt E, Borgstein E, Heij HA (2007) Retrospective study on nephroblastoma in Malawi. Trop Med Health 12(Suppl 1):57
Hara T, Kosaka N, Suzuki T, Kudo K, Niino H (2003) Uptake rates for 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis. A positron emission tomography study. Chest 124(3):893–901
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Hadley, G.P., Naude, F. Malignant solid tumour, HIV infection and tuberculosis in children: an unholy triad. Pediatr Surg Int 25, 697–701 (2009). https://doi.org/10.1007/s00383-009-2409-8
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DOI: https://doi.org/10.1007/s00383-009-2409-8