Profile of Mortality Among Women With Gestational Trophoblastic Disease Infected With the Human Immunodeficiency Virus (HIV): Argument for a New Poor Prognostic Factor

Abstract

Gestational trophoblastic disease (GTD) encompasses a spectrum of conditions ranging from hydatidiform mole to choriocarcinoma. The management of GTD in association with human immunodeficiency virus (HIV) infection is complicated by the interaction between chemotherapy, antiretroviral therapy, and poor performance status due to HIV-related illnesses. This study describes the profile of mortality of women with GTD in the background of HIV infection. A total of 78 patients with GTD were reviewed retrospectively. There were 53 patients with invasive molar pregnancy and 23 patients with choriocarcinoma. The HIV seroprevalence was 31%. There were 15 deaths (19%). There were 8 HIV-infected (33%) and 7 HIV noninfected (13%) who demised. Of the 8 patients with CD4 counts less than 200 cells/microL, 7 patients demised. There were no mortalities among patients with CD4 counts more than 200 cells/microL. Of the 15 deaths, 5 HIV-infected patients and 5 HIV-noninfected patients received chemotherapy. There were 5 patients admitted in very poor general condition precluding the administration of chemotherapy. Among the 10 patients that received chemotherapy and demised, the causes of death included widespread disease, multiorgan failure, and toxicity due to chemotherapy. These findings highlight the poor outcomes of HIV-infected women with CD4 counts less than 200 cells/microL due to poor tolerance to chemotherapy or poor performance status precluding administration of chemotherapy.

High HIV prevalence in gestational trophoblastic neoplasia patients

“…Concurring with our findings, a retrospective South African cohort study of GTN patients between 1999 and 2008, revealed an extremely high HIV prevalence of 184 per 1000 (18%) [9]. Similarly, a retrospective South African study at a different unit between 2003 and 2007 reported an even higher HIV seroprevalence amongst GTD and GTN patients of 308 per 1000 (31%), the majority of whom were of black African ethnicity [10].…”

Gestational trophoblastic disease and human immunodeficiency virus infection: A 10‐year retrospective analysis of patients from the Free State Province, South Africa

“…The HIV‐positive patients with a CD4 count of less than 200 cells/µL had a significantly poorer outcome than the other two groups ( P = 0.03), with 66.7% (95% CI 12.3%–100%) being alive at six months and 33.3% (95% CI 0%–87.7%) at nine months. This was in keeping with the findings reported by Moodley et al, 4 that a statistically significant increase in mortality was noted in HIV‐positive patients with a CD4 count of less than 200 cells/µL. Additionally, HIV status was found to have a statistically significant influence on the presence of metastatic disease in our study, with 60% of patients with metastases being HIV‐positive, compared to 22.2% of patients without metastases ( P =0.03).…”

“…The Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, conducted by the Human Sciences Research Council (HSRC) in 2017, determined that 25.5% of adults between the ages of 15 and 49 years living in the Free State Province of South Africa are HIV‐positive; the Free State Province has the second highest prevalence after KwaZulu‐Natal (27%) 1 . It has been suggested that in patients with gestational trophoblastic disease (GTD), human immunodeficiency virus (HIV) infection with a low CD4 count should be included as a poor prognostic factor 2–5 . The aim of the present study was to describe our data regarding HIV status and GTD to determine whether this is indeed the case.…”

Gestational trophoblastic neoplasm and women living with HIV and/or AIDS

“…Our cases also highlight previous findings of reported studies on GTN and HIV that confirm an associated poor outcome related to chemotherapy in women with HIV and/or AIDS if they present with low CD4 counts, have a poor performance status and an associated poor tolerance to chemotherapy treatment. 10,11…”