title: Altered clinical course of malignant melanoma in HIV-positive patients.
abstract: OBJECTIVE
  To determine whether the natural history of melanoma is different in patients who test positive for human immunodeficiency virus (HIV) compared with matched control subjects.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Ambulatory care at 2 university-affiliated medical centers.
  
  
  METHODS
  Each HIV-positive melanoma patient (n = 17) was randomly matched with 2 HIV-negative patients (HIV status unknown, but without risk factors for HIV) based on the melanoma subtype, tumor thickness, Clark level, tumor location, and sex and age of the patient.
  
  
  METHODS
  Disease-free survival and overall survival of HIV-positive and HIV-negative melanoma patients were compared using a matched-pairs analysis. CD4 cell counts were recorded at the time of melanoma diagnosis and disease recurrence.
  
  
  RESULTS
  Melanoma patients who were HIV positive had a significantly shorter disease-free survival (P =.03) and overall survival (P =.045) compared with HIV-negative melanoma patients by matched-pairs analysis. There was an inverse relationship between CD4 cell counts and time to first melanoma recurrence.
  
  
  CONCLUSIONS
  The natural history of malignant melanoma in HIV-positive patients is more aggressive compared with matched HIV-negative melanoma patients. Altered immune response and comorbid disease may play a role in the poor clinical outcome of HIV-positive patients. These findings have important implications in the management of melanoma in the setting of HIV disease.
authors.affiliation: University of California, San Francisco, Melanoma Center, UCSF Comprehensive Cancer Center, San Francisco, CA 94115, USA.
authors.forename: Lori K E
authors.initials: LK
authors.lastname: Rodrigues
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Klencke
authors.forename: Kirsten
authors.initials: K
authors.lastname: Vin-Christian
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Berger
authors.forename: Richard I
authors.initials: RI
authors.lastname: Crawford
authors.forename: James R
authors.initials: JR
authors.lastname: Miller
authors.forename: Carlos M M
authors.initials: CM
authors.lastname: Ferreira
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nosrati
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashani-Sabet
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001707:Biopsy, Needle; D016022:Case-Control Studies; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000503:physiopathology; D018709:Statistics, Nonparametric; D015996:Survival Rate