Treating neuroendocrine neoplasms in the setting of HIV infection

Abstract

BACKGROUND: There is a paucity of knowledge regarding neuroendocrine neoplasms (NEN) in patients with HIV infection. OBJECTIVE: To explore the incidence, characteristics and treatment outcomes of NEN in HIV-positive individuals. METHODS: This is a single-center, descriptive cohort study. Patients with HIV and biopsy-confirmed NEN were identified from our data registry. Data were collected retrospectively from medical records. Progression-free and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: Nineteen HIV-positive patients with neuroendocrine tumors (NET) (n=14), neuroendocrine carcinomas (NEC) (n=2) or Merkel cell carcinoma (MCC) (n=3) were included (median age at NEN diagnosis, 53 years). In 15 (79%) patients, HIV diagnosis preceded NEN diagnosis by a median of 11 years and 14 were receiving antiretroviral therapy (ART). Of those with data available, 75% had a viral load <50 copies/ml and mean CD4 771 cells/mm3. The median OS in the NEC/MCC cohort was 8 months (range 5-29). The median OS in the NET cohort was not reached but based on the 25th centile, 75% of patients are expected to survive for at least 57 months. Treatment outcomes will be described. CONCLUSIONS: Within the limits of a small descriptive cohort study, we found no evidence in the era of ART that patients with HIV and NEN are diagnosed at a younger age, nor have a poorer prognosis compared with the wider NEN population. Thus, they should receive maximal NEN therapies to support best outcomes.