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Malignancies in UK children with HIV infection acquired from mother to child transmission
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  1. J A Evansa,
  2. D M Gibbb,
  3. F J Hollandb,
  4. P A Tookeyb,
  5. J Pritchardc,
  6. A E Adesb
  1. aDepartment of Paediatrics, Imperial College School of Medicine at St Mary’s, London, bDepartment of Epidemiology and Biostatistics, Institute of Child Health, London, cDepartment of Haematology and Oncology, Great Ormond Street Hospitals for Children NHS Trust, London
  1. Dr D M Gibb, Department of Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London WC1N 1EH.

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.

  • There is an increased incidence of malignant disease, particularly NHL, in children with vertically acquired HIV infection

  • In children affected with HIV less than 5 years of age, the incidence of NHL was about 2500 times greater than expected in the UK child population

  • NHL tends to occur in advanced HIV disease and treatment is complicated by a high risk of infectious complications and poor underlying immune function. Management requires close cooperation between paediatric oncologists and infectious disease specialists

  • Paediatricians now need to consider HIV infection as a predisposing cause of childhood cancer, especially NHL

  • HIV infection
  • malignancy
  • non-Hodgkin’s lymphoma

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