Author/Authors :
Poizot-Martin, I Aix Marseille Universit ́e - APHM Hˆopital Sainte-Marguerite - Service d’Immuno-H ́ematologie Clinique - boulevard de Sainte Marguerite - Marseille Cedex 09, France , Brégigeon, S Aix Marseille Universit ́e - APHM Hˆopital Sainte-Marguerite - Service d’Immuno-H ́ematologie Clinique - boulevard de Sainte Marguerite - Marseille Cedex 09, France , Zaegel-Faucher, O. Aix Marseille Universit ́e - APHM Hˆopital Sainte-Marguerite - Service d’Immuno-H ́ematologie Clinique - boulevard de Sainte Marguerite - Marseille Cedex 09, France , Obry-Roguet, V Aix Marseille Universit ́e - APHM Hˆopital Sainte-Marguerite - Service d’Immuno-H ́ematologie Clinique - boulevard de Sainte Marguerite - Marseille Cedex 09, France , Cano, C.E. Aix Marseille Universit ́e - APHM Hˆopital Sainte-Marguerite - Service d’Immuno-H ́ematologie Clinique - boulevard de Sainte Marguerite - Marseille Cedex 09, France , Ivanova, A Aix Marseille Universit ́e - APHM Hˆopital Sainte-Marguerite - Service d’Immuno-H ́ematologie Clinique - boulevard de Sainte Marguerite - Marseille Cedex 09, France , Tamalet, C Fondation Institut Hospitalo-Universitaire M ́editerran ́ee Infection - Pˆole des Maladies Infectieuses et Tropicales Clinique et Biologique - F ́ed ́eration de Bact ́eriologie-Hygi`ene-Virologie - CHU Timone - rue Saint-Pierre - Marseille Cedex 05, France , R. Bouabdallah, R D ́epartement d’H ́ematologie - Institut Paoli Calmettes - boulevard de Sainte Marguerite - Marseille Cedex 09, France , Solas, C Aix Marseille Universit ́e - AP-HM Hˆopital de la Timone - Service de Pharmacocin ́etique et Toxicologie - CRO2 INSERM U911 - Marseille Cedex 05, France
Abstract :
Non-AIDS-defining cancers represent a rising health issue among HIV-infected patients. Nevertheless, HIV testing isnot systematic during the initial cancer staging. Here, we report a case of HIV infection diagnosed three years after chemotherapyinitiation for multiple myeloma.Results. A 57-year-old woman diagnosed with multiple myeloma underwent a first roundof chemotherapy by bortezomib/lenalidomide and then with bortezomib/liposomal-doxorubicine/dexamethasone, with partialremission, poor hematological tolerance, and multiple episodes of pneumococcal infection. Allogenic stem cell transplantationwas proposed leading to HIV testing, which revealed seropositivity, with an HIV viral load of5.5Log10/mL and severe CD4T cell depletion (24 cells/mm3). Chemotherapy by bendamustin was initiated. Multidisciplinary staff decided the initiation ofantiretroviral 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/mm3), allowing effectivepneumococcal immunization without relapse.Conclusion. Our case illustrates the drawback that ignored HIV infection isstill causing to cancer patients receiving chemotherapy and highlights the importance of early HIV testing in oncology. Amultidisciplinary approach including oncologists/hematologists, virologists, and pharmacists is recommended in order to avoiddrug interactions between chemotherapy and antiretroviral drugs. Moreover, prophylactic medication is recommended in thesepatients regardless of CD4+ cell count at the initiation of chemotherapy
Keywords :
Undiagnosed HIV Infection , 57-Year-Old Woman , Multiple Myeloma , Consequences , Chemotherapy Efficiency , Safety
