Department of Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
Int J Clin Oncol. 2010 Oct;15(5):515-8. doi: 10.1007/s10147-010-0072-7. Epub 2010 May 11.
Human immunodeficiency virus (HIV)-infected patients are likely to develop intracranial events. Due to the spread of highly active antiretroviral therapy (HAART), HIV-infected patients now survive longer, and metastatic non-AIDS-defining carcinoma is increasing. A 49-year-old man with HIV infection undergoing treatment with HAART developed an intratumoral hemorrhage in the right frontal lobe. He was diagnosed as having lung adenocarcinoma and was found to have a brain metastasis with bleeding. After treatment for intratumoral bleeding, a contralateral frontal lobe hemorrhage occurred within a month. The patient underwent a second craniotomy and removal of hematoma, followed by whole-brain radiotherapy. He was then treated with four cycles of cisplatin and gemcitabine combination chemotherapy while receiving HAART. A partial response was achieved, though he developed severe hematological toxicities for which the doses of chemotherapy needed to be decreased. However, as a result of treatment, his activities of daily life recovered gradually. This lung cancer patient had been alive for 17 months despite the coexistence of two disorders with a poor prognosis, HIV infection and bleeding brain metastases from lung cancer. This case revealed that physicians must include non-AIDS-defining cancer metastasis to the brain in the differential diagnosis of HIV-infected patients when they show stroke-like symptoms, and such patients may respond to treatment as well as non-HIV-infected patients with advanced lung cancer.
人类免疫缺陷病毒（HIV）感染患者可能会发生颅内事件。由于高效抗逆转录病毒疗法（HAART）的广泛应用，HIV 感染患者的存活时间更长，转移性非艾滋病定义性癌的发病率也在增加。一位 49 岁的男性 HIV 感染者正在接受 HAART 治疗，其右额叶出现肿瘤内出血。他被诊断为患有肺腺癌，并发现有脑出血伴出血的脑转移。肿瘤内出血治疗后，一个月内对侧额叶发生出血。患者接受了第二次开颅手术和血肿清除术，随后进行了全脑放疗。然后，他接受了四个周期的顺铂和吉西他滨联合化疗，同时继续接受 HAART 治疗。尽管他出现了严重的血液学毒性，需要降低化疗剂量，但还是取得了部分缓解。然而，由于治疗，他的日常生活活动逐渐恢复。尽管存在 HIV 感染和肺癌引起的脑出血这两种预后不良的疾病，但这位肺癌患者仍存活了 17 个月。这个病例表明，当 HIV 感染患者出现类似中风的症状时，医生必须将非艾滋病定义性脑转移纳入鉴别诊断，此类患者可能像非 HIV 感染的晚期肺癌患者一样对治疗有反应。
