Open Access Highly Accessed Research article

HIV-associated bladder cancer: a case series evaluating difficulties in diagnosis and management

Elizabeth M Gaughan1, Bruce J Dezube1, Mark Bower2, David M Aboulafia3, Gerry Bohac4, Timothy P Cooley5 and Liron Pantanowitz6*

Author Affiliations

1 Department of Medicine (Hematology-Oncology), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

2 Department of Oncology, Chelsea and Westminster Hospital, London, UK

3 Division of Hematology and Oncology, Virginia Mason Clinic and the Division of Hematology, University of Washington, Seattle, WA

4 Department of Medicine, Rush University, Chicago, IL, USA

5 Department of Medicine, Lahey Clinic, Burlington, MA, USA

6 Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA

For all author emails, please log on.

BMC Urology 2009, 9:10  doi:10.1186/1471-2490-9-10

Published: 31 August 2009

Abstract

Background

Chronic human immunodeficiency virus (HIV) infection is associated with an increased incidence of Non-Acquired Immunodeficiency Syndrome (non-AIDS) defining cancers. To date, only a limited number of cases of bladder cancer have been linked with HIV infection. We sought to describe the clinical characteristics of HIV-associated bladder cancer.

Methods

A retrospective study was performed involving HIV-positive patients with bladder cancer, combining cases from multiple institutions with published case reports. Data regarding patient demographics, HIV status, clinical presentation, pathology, cancer treatment, and outcome were analyzed using descriptive statistics.

Results

Eleven patients were identified with a median age of 55 years (range, 33 - 67). The median CD4+ count at cancer diagnosis was 280 cells/mm3 (range, 106 - 572 cells/mm3). Six patients (55%) had a known risk factor for bladder cancer, and nine (82%) presented with hematuria. Ten patients had transitional cell carcinoma, and most had superficial disease at presentation. Treatment included mainly transurethral resection of bladder tumor followed by a combination of local and systemic therapies. One patient received intravesical bacillus Calmette-Guèrin (BCG) without complication. Several patients (55%) were alive following therapy, although many (64%) suffered from local relapse and metastatic disease.

Conclusion

Bladder cancer is part of the growing list of cancers that may be encountered in patients living longer with chronic HIV-infection. Our patients presented at a younger age and with only mild immunosuppression, however, they experienced an expected course for their bladder cancer. Hematuria in an HIV-infected patient warrants a complete evaluation.