Prevalence and outcome of HIV-associated malignancies among children

To determine the prevalence, associated factors, and outcome of HIV-associated malignancies among children enrolling for care at the Baylor-Uganda pediatric HIV clinic in Mulago Hospital, Kampala, Uganda.

This was a retrospective case series involving records review of all HIV-infected patients who received care at the Baylor-Uganda clinic in Kampala, Uganda between 1 January 2004 and 31 December 2008.

Medical charts of the clinic patients aged 6 weeks to 18 years were retrieved for data abstraction. Data, including patient's age, sex, diagnosis, type of malignancy, anatomic location of the malignancy, pathology report, baseline laboratory results, and outcome of treatment, were abstracted. Proportions of malignancies among different groups were determined. In addition, Kaplan-Meier survival analysis was conducted. Change in CD4 cell percentages from baseline was assessed with the Wilcoxon signed-rank test.

A total of 109 children with malignancies presented to the clinic during the study period, making up 1.67% of the total children visiting the clinic. Only two types of malignancies, Kaposi's sarcoma (90.7%) and non-Hodgkin's lymphoma (9.3%), were found. Deaths during follow-up were seen in the first few weeks to months. Upon starting treatment, the CD4 cell percentage increased significantly from a baseline median of 6-14% at 6 months to 15.8% at 12 months of follow-up.

HIV-associated malignancies remain an important cause of morbidity and mortality among HIV-infected children in Uganda. Many affected children die in the first weeks of treatment, but those who survive mount good immunologic recovery.