Gestational trophoblastic syndrome and human immunodeficiency virus (HIV) infection: a retrospective analysis

The appropriate management of gynecological malignancies in association with human immunodeficiency virus (HIV) infection is not established. To date the reported literature on the subject consists mainly of case reports. Due to the increasing prevalence of HIV infection, especially in sub-Saharan countries, the chances of finding both conditions in the same patient has produced management and ethical dilemmas. This retrospective study describes the management of 12 HIV-infected patients and compares their outcome with 29 non HIV-infected patients. The mean age of the non HIV-infected patients was 30 years (range 16-56 years), while the mean age of the HIV-infected patients was 32 years (range 20-47 years). In terms of risk factors, there were 72% of non HIV-infected women in the high-risk category compared to 50% of HIV-infected women (P = 0.468). All patients who received treatment had CD4 counts greater than 200 cells/microl. Two HIV-infected women who did not receive any form of chemotherapy due to low CD4 counts (41 cells/microl and 84 cells/microl) demised of their disease. The majority of women (86% non HIV-infected & 90% HIV-infected) received lfewer than 10 cycles of chemotherapy to attain cure. Most side effects were minor. None of the HIV-infected patients who received chemotherapy demised of their disease. In total, irrespective of risk category, there were 38 patients (93%) who were cured of their disease by chemotherapy including 10 HIV-positive patients. All patients were alive and free of disease at their last follow-up visit. Although the numbers are small, it is proposed that HIV-infected patients with choriocarcinoma and a reasonable degree of CD4 counts (>200cells/microl) should receive standard therapy.