From the Guidelines
HIV infection does not directly cause acute leukemia, but it can increase the risk of developing certain malignancies, including hematologic cancers, due to immune dysfunction, chronic inflammation, and co-infection with oncogenic viruses like EBV, as noted in the NCCN guidelines 1. The relationship between Human Immunodeficiency Virus (HIV) infection and the development of acute leukemia is complex and indirect. People with HIV have a higher incidence of non-Hodgkin lymphoma and Hodgkin lymphoma, which are both types of hematologic cancers. However, true acute leukemias, such as Acute Lymphoblastic Leukemia (ALL) or Acute Myeloid Leukemia (AML), are not considered AIDS-defining malignancies. Some key points to consider in the management of HIV-associated hematologic malignancies include:
- The use of effective antiretroviral therapy (ART) to control HIV infection, which has been associated with increased cancer-specific survival and overall survival in people living with HIV (PLWH) and hematologic malignancies, as seen in the context of Hodgkin lymphoma 1.
- The importance of supportive care, including prophylaxis against opportunistic infections, growth factor support, and careful monitoring of drug interactions between chemotherapeutic agents and antiretrovirals.
- The need for individualized treatment approaches, taking into account the specific leukemia classification, patient's immune status, and other clinical factors. It's also worth noting that the prognosis for HIV-positive individuals with hematologic malignancies has improved significantly in the combination antiretroviral therapy (cART) era, with outcomes approaching those of HIV-negative patients when HIV is well-controlled and CD4 counts are maintained. However, the evidence from the provided studies does not directly address the relationship between HIV infection and acute leukemia, with more recent and relevant studies needed to fully understand this relationship, such as those focusing on COVID-19 management in patients with hematological malignancies 1.
From the Research
Relationship between HIV infection and acute leukemia
- The relationship between Human Immunodeficiency Virus (HIV) infection and the development of acute leukemia is complex and not fully understood 2, 3, 4, 5, 6.
- Studies have shown that patients with HIV infection are at a higher risk of developing acute leukemia, particularly acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) 2, 3, 4, 6.
- The use of antiretroviral therapy (ART) has improved the life expectancy of HIV-positive patients, but it is not clear if ART increases or decreases the risk of developing acute leukemia 4, 6.
Treatment outcomes of acute leukemia in HIV-positive patients
- Treatment outcomes of acute leukemia in HIV-positive patients are generally poor, with lower complete remission rates and shorter overall survival compared to HIV-negative patients 2, 4, 6.
- However, some studies have reported promising results with the use of intensive chemotherapy regimens, such as hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD), in combination with ART 2, 4.
- The use of allogeneic hematopoietic stem cell transplantation (HCT) has also been shown to improve survival outcomes in selected HIV-positive patients with acute leukemia 4.
Challenges in treating acute leukemia in HIV-positive patients
- Treating acute leukemia in HIV-positive patients is challenging due to the complexity of the disease, the need for concurrent ART, and the potential for drug interactions between chemotherapy and ART 3, 4, 5, 6.
- There is a need for further research to standardize and improve the treatment of acute leukemia in HIV-positive patients, including the development of evidence-based guidelines and prospective multicenter clinical trials 6.