HCP-01DIAGNOSIS AND MANAGEMENT OF HIGH-GRADE GLIOMA IN PATIENTS WITH HIV

Abstract

BACKGROUND: While opportunistic infections and lymphoma are common causes of a brain mass in immuno suppressed patients with HIV, primary brain tumor is more likely in those with CD4 counts > 500 cells/mm3. Small series have noted a higher than expected frequency of high-grade glioma (HGG) in HIV patients, but they remain rare with fewer than 40 cases reported. This study adds 4 from an inner city population. METHODS: Retrospective case series. Chart review. RESULTS: Four patients were identified - 3 women with GBM and 1 man with anaplastic astrocytoma (AA). Median age at tumor diagnosis was 57.5 (range 48-66). All patients were on HAART at time of diagnosis and median CD4 count was 516 cells/mm3 (range 359-888 cells/mm3). For 3 patients with available data, median time between HIV and HGG diagnoses was 5 years (range 2-8). Median time from presentation to HGG diagnosis was 34 days (range 9-59). At presentation, HGG was considered the most likely diagnosis for all GBM patients; differential for the AA patient included low-grade glioma, infectious or inflammatory process. Three patients underwent CSF sampling to investigate alternate diagnoses. Empiric toxoplasmosis therapy was initiated in 1, but stopped after 4 days. All patients underwent subtotal resection followed by chemo-radiation with temozolomide (TMZ). No patient required dose reduction for hematological toxicity. One experienced a drop in CD4 count to 29 cells/mm3 despite undetectable viral load. Two patients received therapy at recurrence; agents included bevacizumab and irinotecan. Three died (OS range 4-17 months); 1 remains alive 22 months from diagnosis. CONCLUSIONS: HGG should be a strong diagnostic consideration in immune-competent HIV patients presenting with brain mass. Additional testing for toxoplasmosis and lymphomais low-yield and should not delay surgical diagnosis. Treatment for HGG in such patients should be the same as the general population.