Chawki Sylvain, Ploussard Guillaume, Montlahuc Claire, Verine Jérome, Mongiat-Artus Pierre, Desgrandchamps François, Molina Jean-Michel
Infectious Diseases, Saint Louis Hospital, Paris, France.
Urology, Saint Louis Hospital, Paris, France.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19647. doi: 10.7448/IAS.17.4.19647. eCollection 2014.
As HIV-infected patients get older more non-AIDS-related malignancies are to be seen. Cancer now represents almost one third of all causes of deaths among HIV-infected patients (1). Albeit bladder cancer is one of the most common malignancy worldwide (2), only 13 cases of bladder cancer in HIV-infected patients have been reported in the literature so far (3).
We conducted a monocentric study in our hospital. We selected all patients who were previously admitted (from 1998 to 2013) in our hospital with diagnoses of HIV and bladder cancer. The objective was to assess the prevalence and characteristics of bladder cancers in HIV-infected patients in our hospital.
Based on our administrative HIV database (6353 patients), we found 15 patients (0.2%) with a bladder cancer. Patients' characteristics are presented in Table 1. Patients were mostly men and heavy smokers. Their median nadir CD4 cell count was below 200 and most had a diagnosis of AIDS. A median time of 14 years was observed in those patients, between the diagnosis of HIV-infection and the occurrence of bladder cancer, although in patients much younger (median age 56) than those developing bladder cancer without HIV infection (71.1 years) (4). Haematuria was the most frequent diagnosis circumstance in HIV-infected patients who had relatively preserved immune function on highly active antiretroviral therapy (HAART). Histopathology showed relatively advanced cancers at diagnosis with a high percentage of non transitional cell carcinoma (TCC) tumor and of TCC with squamous differentiation, suggesting a potential role for human papilloma virus (HPV) co-infection. Death rate was high in this population.
Bladder cancers in HIV-infected patients remain rare but occur in relatively young HIV-infected patients with a low CD4 nadir, presenting with haematuria, most of them being smokers, and have aggressive pathological features that are associated with severe outcomes.
随着感染HIV的患者年龄增长，更多非艾滋病相关的恶性肿瘤被发现。癌症目前几乎占HIV感染患者所有死因的三分之一（1）。尽管膀胱癌是全球最常见的恶性肿瘤之一（2），但迄今为止，文献中仅报道了13例HIV感染患者的膀胱癌病例（3）。
我们在我院进行了一项单中心研究。我们选取了所有曾于1998年至2013年期间在我院住院且被诊断为HIV和膀胱癌的患者。目的是评估我院HIV感染患者中膀胱癌的患病率和特征。
基于我们的HIV管理数据库（6353例患者），我们发现了15例（0.2%）膀胱癌患者。患者特征见表1。患者多为男性且吸烟量大。他们的CD4细胞计数最低点中位数低于200，大多数患者被诊断为艾滋病。在这些患者中，从HIV感染诊断到膀胱癌发生的中位时间为14年，尽管这些患者比未感染HIV而患膀胱癌的患者年轻得多（中位年龄56岁）（未感染HIV患膀胱癌患者中位年龄为71.1岁）（4）。血尿是在接受高效抗逆转录病毒治疗（HAART）且免疫功能相对保留的HIV感染患者中最常见的诊断情况。组织病理学显示诊断时癌症相对晚期，非移行细胞癌（TCC）肿瘤和伴有鳞状分化的TCC比例较高，提示人乳头瘤病毒（HPV）合并感染可能起作用。该人群死亡率较高。
HIV感染患者中的膀胱癌仍然罕见，但发生在CD4最低点较低的相对年轻的HIV感染患者中，表现为血尿，其中大多数为吸烟者，并且具有与严重后果相关的侵袭性病理特征。
