Distinct Clinical Characteristics of Myelodysplastic Syndrome in Human Immunodeficiency Virus-Infected Patients,

Human Immunodeficiency Virus (HIV) infection has known to increase the risk of several malignancies including B-cell non-Hodgkin's lymphoma and Kaposi's sarcoma. With the prolonged survival of HIV-infected patients conferred by the use of effective anti-retroviral and prophylactic strategies, other malignancies, including Hodgkin's disease and solid tumors, have also been reported in this setting, although relationship with HIV infection is still not fully understood. HIV infected patients also can manifest multiple hematologic abnormalities and bone marrow specimens in most of those cases reveal so called myelodysplastic features. However bona fide myelodysplastic syndrome (MDS) is not common in this population and its real incidence, clinical course and outcome is yet unknown.

The aim of this study is to compare the clinical characteristics and outcome of HIV associated MDS to non-HIV MDS.

This is a retrospective cohort study of 81 patients who were diagnosed with MDS in our allied three teaching hospitals in New York City from 2005 to 2010. Available clinical history, pathological data, cytogenetic studies, and laboratory data were obtained through electronic medical records. HIV was confirmed by enzyme-linked immunosorbent assay (ELISA) testing with western blot confirmation as well as HIV-1/2 viral PCR. MDS diagnosis was confirmed with bone marrow morphology, laboratory data, and cytogenetic studies and was classified both according to the French-American-British (FAB) classification and World Health Organization (WHO) criteria.

Of 81 patients, 9 patients had confirmed HIV status and 72 were non-HIV. HIV positive group was consisted with younger patients (mean age 55.7 vs 72.7 p<0.01). Other baseline characteristics such as sex, laboratory profile, blast count and MDS classification were not significantly different between two groups. Cytogenetic studies were available in 79/81 patients (9/9 in HIV positive group and 70/72 in non-HIV group). Cytogenetic abnormalities were more frequently seen in HIV positive group compared to non HIV group (89% vs 47% p <0.05). When stratified by International Prognostic Scoring System (IPSS), HIV positive group carried worse prognostic karyotypes (67% vs 27%, p<0.05). Of those, chromosome 7 was more frequently found to be abnormal in HIV positive group (75% vs 33%, p<0.05). There was no statistically significant difference of abnormalities in other chromosomes between two groups. Survival data was available in 61/81 patients (9/9 in HIV positive group and 52/72 in non HIV group). Median survival of HIV positive group was 8 months and non-HIV MDS group was 66 months (Log rank p=0.013).

In this retrospective analysis, when compared to non HIV-MDS, HIV-MDS is associated with a higher incidence of poor prognostic karyotype abnormalities and has poorer survival outcome after the diagnosis of MDS. To the best of our knowledge, this is the first report that compared clinical features of HIV-MDS and non HIV-MDS. Although further prospective controlled observations are needed to confirm these results, these findings suggest that HIV status can be one of the poor prognostic factors in MDS patients, and may prompt consideration of early intervention or treatment.

No relevant conflicts of interest to declare.