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Malignancies in South African Children With HIV

Davidson, Alan MD, MPhil; Wainwright, Rosalinda D. MD; Stones, David K. MD; Kruger, Mariana MD, PhD; Hendricks, Marc MD; Geel, Jennifer MD; Poole, Janet MD; Reynders, David MD; Omar, Fareed MD; Mathew, Rema MD; Stefan, D. Cristina MD, PhD

Journal of Pediatric Hematology/Oncology: March 2014 - Volume 36 - Issue 2 - p 111–117
doi: 10.1097/MPH.0b013e31829cdd49
Original Articles

Objectives: In 2008 the South African Children’s Cancer Study Group decided to review the epidemiology, management, and chemotherapy response of HIV-positive children with malignancy.

Methods: This is a retrospective analysis of data collected from the records of HIV-positive children diagnosed with malignancy at 7 university-based pediatric oncology units serving 8 of the 9 provinces in South Africa.

Results: Two hundred eighty-eight HIV-positive children were diagnosed with 289 malignancies between 1995 and 2009. Age at diagnosis ranged from 17 days to 18.64 years; median 5.79 years. Of the 220 HIV-associated malignancies, there were 97 Kaposi sarcomas, 61 Burkitt lymphomas, 47 other B-cell lymphomas including 2 primary central nervous system lymphomas, 12 Hodgkin lymphomas, and 3 leiomyosarcomas. Sixty-nine patients presented with non–AIDS-defining malignancies. More than 80% presented with advanced disease. Most patients (76.7%) were naive to antiretroviral therapy; 22.2% did not have access because it only became available in public hospitals in 2004. One hundred ninety-seven children were treated with curative intent; 91 received palliative care due to advanced malignancy and/or advanced HIV disease. Nearly one third had coexisting pathology, mostly tuberculosis. Overall survival for the whole group was 33.7%, but was 57.8% for those treated with antiretroviral therapy and chemotherapy.

Conclusions: The study shows more Kaposi sarcoma and fewer primary central nervous system lymphomas among HIV-positive children than that is reported in the developed world, but confirms a higher incidence of non-Burkitt B-cell lymphoma than in HIV-negative children. The high number of non–AIDS-defining malignancies underscores the prevalence of HIV-AIDS in South Africa. The overall survival should improve with universal access to antiretrovirals and earlier diagnosis.

*Department of Paediatrics and Child Health, Red Cross Children’s Hospital and the University of Cape Town

§Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Tygerberg, Cape Town, Western Cape

Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital

Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg

Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, Gauteng

Department of Paediatrics and Child Health, Universitas Academic Hospital Complex and the University of the Free State, Bloemfontein, Free State

#Department of Paediatrics, Frere Hospital and Walter Sisulu University, East London, Eastern Cape

The authors declare no conflict of interest.

Reprints: Alan Davidson, MD, MPhil, Department of Paediatrics and Child Health, Ward G1, Red Cross Children’s Hospital, Private Bag, Rondebosch, Cape Town 7700, South Africa (e-mail: alan.davidson@uct.ac.za).

Received December 2, 2012

Accepted April 22, 2013

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