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Hagiwara S.,National Medical Center for Global Health and Medicine | Yotsumoto M.,Tokyo Medical University | Odawara T.,Tokyo Medical University | Ajisawa A.,Tokyo Metropolitan Cancer and Infectious Diseases Center | And 4 more authors.
AIDS | Year: 2013

OBJECTIVE: To clarify the incidence and clinical outcomes of non-AIDS-defining hematological malignancies (NADHMs), excluding non-Hodgkin's lymphomas, in HIV-infected patients. DESIGN: A nationwide epidemiological study was conducted to evaluate the incidence and clinical outcomes of NADHMs. METHODS: Questionnaires were sent to 429 regional AIDS centers and 497 educational hospitals certified by the Japanese Society of Hematology. Data from 511 institutes were obtained. RESULTS: From 1991 to 2010, 47 patients with NADHMs were detected (median age, 42.0 years; male, 93.6%). The median CD4-positive T-cell count was 255/μl, and the median duration from the diagnosis of HIV infection to development of hematological malignancy was 28.0 months. Most patients with acute leukemia were treated with standard induction chemotherapy. Complete remission rates and median overall survival periods for acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL) were 70.0 and 85.7% and 13 and 16 months, respectively. Three of four patients with chronic-phase chronic myeloid leukemia (CML-CP) were well controlled with imatinib. Five patients (2 AML, 1 ALL, 1 accelerated-phase CML, and 1 myeloma) were treated with autologous or allogeneic stem-cell transplantation. Comparison of patients over the two periods (1991-2000 and 2001-2009) revealed a 4.5-fold increase in the incidence of hematological malignancies. CONCLUSION: The incidence of NADHMs has increased in the past decade. The prognosis of these patients was similar to that of HIV-negative patients; therefore, standard chemotherapy may be a feasible treatment option for HIV-infected patients with hematological malignancies. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Watanabe D.,Medical Center | Yoshino M.,National Hospital Organization Osaka | Yagura H.,National Hospital Organization Osaka | Hirota K.,Medical Center | And 10 more authors.
Journal of Infection and Chemotherapy | Year: 2012

Recently, 2 monoclonal antibodies that specifically inhibit mitochondrial creatine kinase (MtCK) activity have been developed. In this study, we measured the serum MtCK activity in HIV-1-infected individuals (n = 100) by employing a novel method using these antibodies. The mean serum MtCK activity in 44 patients treated with highly active antiretroviral therapy (HAART) including tenofovir disoproxil fumarate (TDF) was 16.0 IU/L. The MtCK activity was significantly higher in patients receiving TDF than in those receiving HAART without TDF (3.4 IU/ L) or in naïve patients (6.9 IU/L) (Tukey-Kramer test, p<0.0001 and p = 0.0029, respectively). The serum MtCK activity reached a plateau at 1 month after the initiation of TDF administration and decreased upon discontinuation. It showed no significant correlation with the trough plasma TDF concentration, serum creatinine level, or red blood cell count. The activity was elevated in 75% of the patients receiving TDF, and this elevation was specific to TDF; it was not observed with other anti-HIV drugs. In addition, our report emphasizes the careful interpretation of creatine kinase-MB (CK-MB) test results in patients receiving TDF because MtCK in serum could cause falsepositive results on a conventional CK-MB test, which does not include MtCK-specific inhibitory antibodies. © Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases 2012. Source

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