Malignancies in UK children with HIV infection acquired from mother to child transmission

Abstract

By April 1995, 302 cases of vertically acquired HIV infection had been reported through the British Paediatric Association Surveillance Unit. Over 50% of these children had developed an AIDS indicator disease, including nine malignancies (seven cases of non-Hodgkin's lymphoma (NHL) and two of Kaposi's sarcoma). There were two other malignancies that were not AIDS indicator diseases. In children less than 5 years of age the incidence of NHL was approximately 2500 times greater than expected in the UK child population. Three children presented with NHL as their AIDS indicator disease and four developed NHL at a median of 14 (range 10-19) months after the initial diagnosis of AIDS. Six of the seven children died at a median of 6.5 (range 2-14) months after the diagnosis of NHL. The seventh child responded to treatment and is alive nearly four years later. Histology was available in five cases, of which four were of B cell and one of T cell origin. Epstein-Barr virus was detected in all three patients with NHL where it was sought; all had B cell lymphomas. Although comparatively rare, malignancies occur in children infected with HIV and may be the presenting illness. Paediatricians now need to consider HIV infection as a predisposing cause of childhood cancer, especially NHL.

Malignancy in Perinatally Human Immunodeficiency Virus-Infected Children in the United States

“…13 The overall cancer incidence of 1.56/1000 person-years documented in this study was lower than the cancer incidence of 3.57/1000 person-years documented in children in Italy, 5 and the NHL incidence of 14.2/1000 person-years documented in children in the United Kingdom. 4 This could indicate that the PACTG 219/219C cohort generally enrolled healthier children with HIV infection to the exclusion of children with more advanced HIV disease. Indeed the CD4 ϩ T cell percentages indicated that most children were immunocompetent at cohort enrollment and at the last cohort visit.…”

“…3 European cohort studies have documented an NHL incidence of 14.2/1000 children/year in the United Kingdom and 3.57/1000 person-years in Italy, which were 2500 and 20 times higher than rates in the general pediatric population, respectively. 4,5 Although the immunosuppression of HIV disease in cancer pathogenesis is recognized, the etiology of cancer in pediatric HIV infection is not well-understood. 6 In the Italian pediatric cohort, cancer incidence increased with severity of Centers for Disease Control HIV clinical classification (A, B or C).…”

Mucocutaneous manifestations in children with human immunodeficiency virus infection

“…In a British study, seven cases of NHL were identified among 302 HIV-infected children. [61] Hair and Nail changes Hair abnormalities: Hair changes such as hypertrichosis of the eyelashes, thinning of hair, premature graying, telogen effluvium, and alopecia (due to severe SD, malnutrition or unknown causes) have been reported to occur in HIV infection. [34,45] Nail abnormalities: Nail changes such as yellow discoloration, transverse or longitudinal ridging, paronychia, onychomycosis, etc.…”

Survival of HIV-1 vertically infected children

“…Cancer is ≥5–10 times more common in HIV-infected compared to uninfected children [87,91,111,112,113]. In the cART era, AIDS-defining cancers (ADCs) have reduced dramatically, but non-ADC rates remain unchanged or increased [87,91,114].…”