Altered Clinical Course of Malignant Melanoma in HIV-Positive Patients

Abstract

To determine whether the natural history of melanoma is different in patients who test positive for human immunodeficiency virus (HIV) compared with matched control subjects.Design: Retrospective cohort analysis.Setting: Ambulatory care at 2 university-affiliated medical centers.Patients: Each HIV-positive melanoma patient (n=17) was randomly matched with 2 HIV-negative patients (HIV status unknown, but without risk factors for HIV) based on the melanoma subtype, tumor thickness, Clark level, tumor location, and sex and age of the patient.Main Outcome Measures: Disease-free survival and overall survival of HIV-positive and HIV-negative melanoma patients were compared using a matched-pairs analysis. CD4 cell counts were recorded at the time of melanoma diagnosis and disease recurrence.Results: Melanoma patients who were HIV positive had a significantly shorter disease-free survival (P =.03) and overall survival (P =.045) compared with HIV-negative melanoma patients by matched-pairs analysis. There was an inverse relationship between CD4 cell counts and time to first melanoma recurrence. Conclusions:The natural history of malignant melanoma in HIV-positive patients is more aggressive compared with matched HIV-negative melanoma patients. Altered immune response and comorbid disease may play a role in the poor clinical outcome of HIV-positive patients. These findings have important implications in the management of melanoma in the setting of HIV disease.

Melanoma in Immunosuppressed Patients

“…89 Clinical Course in Patients With HIV Infection/AIDS The presence of immunosuppression may accelerate the progression of melanoma, especially in persons who already are predisposed to melanoma. 89,90,93,94 This logic seems to apply also to the population with HIV infection/AIDS. In one study, the disease-free survival and overall survival for HIV-infected patients with melanoma were significantly shorter than for the HIV-negative melanoma control group, with at least 40% of the HIV-positive melanoma patients dying of metastatic melanoma.…”

“…In one study, the disease-free survival and overall survival for HIV-infected patients with melanoma were significantly shorter than for the HIV-negative melanoma control group, with at least 40% of the HIV-positive melanoma patients dying of metastatic melanoma. 94 Most studies point to HAART and its associated immune reconstitution as possible sources of improved prognosis in patients with HIV infection and melanoma. 94 The study by Burgi et al 91 showed that HAART had a protective effect against the development of non-AIDS-defining cancer.…”

“…94 Most studies point to HAART and its associated immune reconstitution as possible sources of improved prognosis in patients with HIV infection and melanoma. 94 The study by Burgi et al 91 showed that HAART had a protective effect against the development of non-AIDS-defining cancer. Yet, this same conclusion did not apply to melanoma because of the study's small number of melanoma patients.…”

“…91,95 Thus, the relationship is still unclear among CD4 count, HAART, HIV RNA viral load, and melanoma incidence, as well as disease course. [94][95][96] HIV and Immune Modulation Although the mechanism of HIV's impact on melanoma is still unclear, some evidence suggests the role of immune modulation. Specifically, a 2007 study found a similarity in the pattern of increased cancer risk when evaluating both patients with HIV infection and OTRs.…”

“…Specifically, a 2007 study found a similarity in the pattern of increased cancer risk when evaluating both patients with HIV infection and OTRs. 42 Human immunodeficiency virus infection is associated with production of T H 2 cytokines that promote HIV proliferation, immune evasion, the transcription of some oncogenes, and overall decreased apoptosis of infected cells and de- Other studies have found dysfunctional B-cell activation and regulation in AIDS patients, leading to immunoregulatory dysfunction-all possible contributors to melanoma development in these patients (Lane et al 1983, as cited in Rodrigues et al 94 ).…”