High cancer incidence in perinatally HIV-infected children

Children infected with HIV around the time of birth face a significantly higher cancer risk than uninfected children, according to a report in the November 15th issue of the Journal of Clinical Oncology. In an effort to clarify the association between perinatal HIV infection and the development of malignancies, Dr. D. Caselli, from Instituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, in Pavia, and colleagues evaluated data from the Italian Register for HIV Infection in Children.

Thirty-five children of 1,331 HIV-infected children observed for a median 6.5 years developed 36 malignancies at a median age of 5.6 years (range, 0.3 to 13.0 years), the authors report. Most were vertically infected, although some were infected parentally or had indeterminate risk factors. Among the 1163 vertically infected children, the cumulative incidence of HIV-related tumours was 4.18 per 1,000 children per year, the report indicates. The death rate in this group was 54.4 per 1,000 children per year. Among the 569 vertically infected children prospectively followed from birth, the HIV-related tumour rate was similar (3.57 per 1000 children per year), the researchers note, though their death rate was higher (69.8 per 1000 children per year).

The most common tumour was non-Hodgkin’s lymphoma (NHL), and many children with NHL responded satisfactorily to chemotherapy. Nine of thirteen treated with a standard protocol remained in complete remission a median 48 months after treatment. Other cancers, including splenic sarcoma, Hodgkin’s disease and leiomyoma of the gallbladder, responded less well to treatment, the investigators add, though one child who developed hepatoblastoma at age 5 was alive and cancer-free at age 17.

“The risk of cancer was significantly higher but not restricted to symptomatic and/or immune-compromised children,” the authors conclude. “Cancer-directed treatment should be given promptly to these patients, who have a fair chance to survive their tumour in view of potential highly aggressive antiretroviral therapy-associated improvement in survival and quality of life.”