Chronic Lymphocytic Leukemia in a Man with Human Immunodeficiency Virus: a Case Report.

The human immunodeficiency virus (HIV) has a well-established association with aggressive B-cell lymphoproliferative disorders, including non-Hodgkin's lymphoma and Hodgkin's disease. Despite this relationship, however, B-cell chronic lymphocytic leukemia (CLL) is rarely observed. We report a patient with HIV subsequently diagnosed with CLL.

A 61-year-old African-American man was referred to our hematology clinic for evaluation of asymptomatic lymphocytosis noted on routine blood testing. His past medical history was notable for a diagnosis of HIV 9 years prior, and his disease was well-controlled on antiretroviral therapy (ARVT). Prior to this, his blood counts were normal. He has no history of malignancy in the family or known radiation or chemical exposure. The patient denied constitutional symptoms and lymphadenopathy was absent on exam. His complete blood count revealed an absolute lymphocyte count of 9,000 cells per microliter without abnormalities in his platelet count or hemoglobin. A review of the peripheral smear revealed a population of monomorphous, mature-appearing lymphoid cells with clumped chromatin. His other cell lines were preserved and normal in appearance. Flow cytometry of the peripheral blood revealed CD5+, CD19+, CD20+ (dim), CD23+, CD10-, kappa-restricted lymphocytes. Serologies for Epstein-Barr virus and human T-cell lymphotropic virus types 1 and 2 were negative. His presentation and subsequent findings were consistent with Rai stage 0 CLL. He has not received treatment for his disease and he continues to have persistent but stable lymphocytosis. His HIV remains controlled with ARVT.

Despite the association observed between HIV and B-cell malignancies, prior observational studies have not demonstrated a relationship between CLL and HIV. Knowles et al (Ann Intern Med 1988;108:744-753) examined 105 patients with AIDS and lymphocytic neoplasia. Although 3 cases had CLL, they were of the T-cell variant. Similarly, Analo et al (Cent Afr J Med 1998;44:130-134) examined the rates of HIV in patients with lymphoid malignancies. Of the 10 patients with CLL, none of them had HIV. Reflecting the apparently rare relationship between HIV and CLL, we are aware of only two previously published reports of CLL and HIV. The first report, published by Ravandi et al (Leuk Res 2003;27:853-857), involved a 65-year-old African-American man with ARVT-controlled HIV who was diagnosed with CLL after presenting with lymphocytosis and cervical, axillary, and inguinal lymphadenopathy. The second report was authored by Levine et al (Cancer 2002;94:1500-1506) and retrospectively described 10 patients out of 410 in their AIDS-lymphoma registry with indolent lymphoid malignancies, of which 2 had small lymphocytic lymphoma. The mechanism for this relationship remains unknown. HIV-related T-cell dysfunction leading to a monoclonal B-cell population is a postulated mechanism for HIV-related lymphoproliferative disorders. Why CLL is less common than other B-cell diseases remains unexplained. One cannot rule out the possibility that the recent reports of CLL and HIV may reflect longer survival of patients with HIV as opposed to a direct pathogenic relationship between the two diseases. Further identification of similar cases is needed and investigation of the relationship of these two diseases may provide a better understanding of the pathogenesis of CLL.

No relevant conflicts of interest to declare.