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Multicenter Study of Human Immunodeficiency Virus–Related Germ Cell Tumors

From the Chelsea and Westminster Hospital, St Bartholomew’s & Royal London Hospital, Guys and St Thomas Hospital, and Royal Free Hospital, London; Royal Sussex County Hospital, Brighton, United Kingdom; and Rigshospitalet, Copenhagen, Denmark.

Address reprint requests to Mark Bower, PhD, Department of Oncology, Chelsea & Westminster Hospital, 369 Fulham Rd, London SW10 9NH, United Kingdom; email: m.bower{at}ic.ac.uk.

Purpose: Testicular germ cell tumors (GCT) occur at increased frequency in men with human immunodeficiency virus (HIV). This multicenter study addresses the characteristics of these tumors.

Patients and Methods: Patients with HIV-related GCT were identified from six HIV treatment centers. The incidence was calculated from the center with the most complete linked oncology and HIV databases.

Results: Thirty-five patients with HIV-related GCT were identified. The median age at GCT diagnosis was 34 years (range, 27 to 64 years). The median CD4 cell count was 315/mm³ (range, 90 to 960/mm³) at this time. The histologic classification was seminoma in 26 patients (74%) and nonseminomatous GCT in nine patients (26%). Twenty-one patients (60%) had stage I disease and 14 patients had metastatic disease. Overall six patients relapsed, three died from GCT, and seven died from HIV disease, resulting in a 2-year overall survival rate of 81%. HIV-related seminoma occurred more frequently than in the age- and sex-matched HIV-negative population, with a relative risk of 5.4 (95% confidence interval, 3.35 to 8.10); however, nonseminomatous GCT did not occur more frequently, and there was no change in the incidence of GCT since the introduction of highly active antiretroviral therapy.

Conclusion: Testicular seminoma occurs significantly more frequently in HIV-positive men than in the matched control population. Patients with HIV-related GCTs present and should be treated in a similar manner to those in the HIV-negative population. After a median follow-up of 4.6 years, 9% of the patients died from GCT. Most of the mortality relates to HIV infection.

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