title: A Case of Undiagnosed HIV Infection in a 57-Year-Old Woman with Multiple Myeloma: Consequences on Chemotherapy Efficiency and Safety.
abstract: Background. Non-AIDS-defining cancers represent a rising health issue among HIV-infected patients. Nevertheless, HIV testing is not systematic during the initial cancer staging. Here, we report a case of HIV infection diagnosed three years after chemotherapy initiation for multiple myeloma. Results. A 57-year-old woman diagnosed with multiple myeloma underwent a first round of chemotherapy by bortezomib/lenalidomide and then with bortezomib/liposomal-doxorubicine/dexamethasone, with partial remission, poor hematological tolerance, and multiple episodes of pneumococcal infection. Allogenic stem cell transplantation was proposed leading to HIV testing, which revealed seropositivity, with an HIV viral load of 5.5 Log10/mL and severe CD4 T cell depletion (24 cells/mm(3)). Chemotherapy by bendamustin was initiated. Multidisciplinary staff decided the initiation of antiretroviral therapy with tenofovir/emtricitabin/efavirenz and prophylaxis against opportunistic infections. After 34 months, patient achieved complete remission, sustained HIV suppression, and significant CD4 recovery (450 cells/mm(3)), allowing effective pneumococcal immunization without relapse. Conclusion. Our case illustrates the drawback that ignored HIV infection is still causing to cancer patients receiving chemotherapy and highlights the importance of early HIV testing in oncology. A multidisciplinary approach including oncologists/hematologists, virologists, and pharmacists is recommended in order to avoid drug interactions between chemotherapy and antiretroviral drugs. Moreover, prophylactic medication is recommended in these patients regardless of CD4+ cell count at the initiation of chemotherapy.
authors.affiliation: Aix Marseille Université, APHM Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, 270 boulevard de Sainte Marguerite, 13274 Marseille Cedex 09, France; INSERM U912 (SESSTIM), 13006 Marseille, France.
authors.forename: I
authors.identifier: 0000-0002-5676-5411
authors.initials: I
authors.lastname: Poizot-Martin
authors.affiliation: Aix Marseille Université, APHM Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, 270 boulevard de Sainte Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: S
authors.initials: S
authors.lastname: Brégigeon
authors.affiliation: Fondation Institut Hospitalo-Universitaire Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, CHU Timone, 264 rue Saint-Pierre, 13385 Marseille Cedex 05, France.
authors.forename: C
authors.initials: C
authors.lastname: Tamalet
authors.affiliation: Département d'Hématologie, Institut Paoli Calmettes, 232 boulevard de Sainte Marguerite, 13273 Marseille Cedex 09, France.
authors.forename: R
authors.initials: R
authors.lastname: Bouabdallah
authors.affiliation: Aix Marseille Université, APHM Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, 270 boulevard de Sainte Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: O
authors.initials: O
authors.lastname: Zaegel-Faucher
authors.affiliation: Aix Marseille Université, APHM Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, 270 boulevard de Sainte Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: V
authors.initials: V
authors.lastname: Obry-Roguet
authors.affiliation: Aix Marseille Université, APHM Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, 270 boulevard de Sainte Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: A
authors.initials: A
authors.lastname: Ivanova
authors.affiliation: Aix Marseille Université, APHM Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, 270 boulevard de Sainte Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: C E
authors.initials: CE
authors.lastname: Cano
authors.affiliation: Aix Marseille Université, AP-HM Hôpital de la Timone, Service de Pharmacocinétique et Toxicologie, CRO2 INSERM U911, 13385 Marseille Cedex 05, France.
authors.forename: C
authors.initials: C
authors.lastname: Solas