Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
Indian J Sex Transm Dis
The Journal | Search | Ahead Of Print | Current Issue | Archives | Instructions | Subscribe | Login    Users online: 779   Home Email this page Print this page Bookmark this page Decrease font size Default font size Increase font size


 
  Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 36  |  Issue : 2  |  Page : 195-197
 

Thyroid cancer in a long-term nonprogressor HIV-1 infection


1 Department of Medical Oncology, Medical Oncology Unit II, Shri Siddhivinayak Ganapati Cancer Hospital, Miraj, Sangli, Maharashtra, India
2 Department of Surgical Oncology, Shri Siddhivinayak Ganapati Cancer Hospital, Miraj, Sangli, Maharashtra, India
3 Department of Oncopathology, Shri Siddhivinayak Ganapati Cancer Hospital, Miraj, Sangli, Maharashtra, India

Date of Web Publication12-Oct-2015

Correspondence Address:
Uday A Phatak
Consultant Physician, Medical Oncology Unit II, Shri Siddhivinayak Ganapati Cancer Hospital, Miraj - 416 410, Sangli, MH
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7184.167175

Rights and Permissions

 

   Abstract 

Long-term non-progressor HIV infection (LTNP-HIV) is seen in <1 percent of HIV-afflicted population. There are definite criteria for the diagnosis of LTNP-HIV. Malignancies either solid tumors or haematological cancers have not been reported in such population. We report here a rare case of follicular thyroid carcinoma in LTNP-HIV infection. She never had any opportunistic infections. She did not receive anti-retroviral therapy in the entire course of illness and continued to have good quality of life. Treatment of follicular thyroid cancer was similar to other patients without HIV infection. This could be the first case study from India.


Keywords: Follicular thyroid cancer, HIV-1, long-term nonprogressor HIV infection


How to cite this article:
Phatak UA, Chitale P V, Jagdale RV. Thyroid cancer in a long-term nonprogressor HIV-1 infection. Indian J Sex Transm Dis 2015;36:195-7

How to cite this URL:
Phatak UA, Chitale P V, Jagdale RV. Thyroid cancer in a long-term nonprogressor HIV-1 infection. Indian J Sex Transm Dis [serial online] 2015 [cited 2019 Nov 15];36:195-7. Available from: http://www.ijstd.org/text.asp?2015/36/2/195/167175



   Introduction Top


Long-term nonprogressor HIV infection (LTNP-HIV) is seen in <1% HIV positive population. Natural history of this subset of patients is entirely different. [1] So far, there are no studies on cancers in LTNP-HIV patients in the literature. We report here a very rare case of follicular thyroid carcinoma in LTNP-HIV infection. This could be the first case report from India.


   Case report Top


A 30-year-old female, doctor by profession, presented with midline painless swelling in the neck for 3 months. It was slowly progressive but did not cause any pressure effects on nearby structures. She was having HIV-1 infection for last 10 years. She never had fever, weight loss, or any opportunistic infections due to HIV-1 infection. Details of investigations done 10 years ago such as HIV-1 viral load and CD4 and CD8 counts are not available at present. She was never treated with prophylactic drug treatment for opportunistic infections or with antiretroviral therapy during this period. She never suffered from thyroid illness before. None of her family members had history of thyroid dysfunction.

Clinical examination revealed a solitary nodule of 4 cm in the left lobe of thyroid. Cervical lymphadenopathy was not found. Ultrasonic study of thyroid gland showed an isoechoic solid nodule. Fine-needle aspiration cytology reported as a cellular follicular lesion. Thyroid function tests were normal. She underwent left hemithyroidectomy. Histopathological gross evaluation of left hemithyroidectomy specimen measuring 6.3 × 6.3 × 3.0 cm showed a well-circumscribed homogenous, nodular brownish mass measuring 4.5 × 3.5 × 2.8 cm. Adjacent nonneoplastic thyroid was nodular grey-white. Microscopy revealed a widely invasive, follicular carcinoma demonstrating prominent capsular and vascular invasion with tumor plug completely transregressing the fibrous capsule and present within a blood vessel covered by endothelium. No extra-thyroid extension was seen. Adjacent thyroid parenchyma shows lymphocytic thyroiditis [Figure 1]. There was no spread to other organs. Stage I follicular carcinoma was diagnosed.
Figure 1: Widely invasive follicular carcinoma of thyroid. Arrow shows capsular invasion. Inset shows adjacent Hashimoto's thyroiditis

Click here to view


Completion thyroidectomy was performed. Histopathological evaluation of completion thyroidectomy specimen showed Hashimoto's thyroiditis. Eleven adjacent lymph nodes were free of tumor. After 4 weeks, she underwent radioactive-Iodine whole body scan that demonstrated residual disease in the neck. Radioiodine ablation of the disease was done. She was treated with levothyroxine 100 μg daily for hypothyroidism after radioiodine treatment and calcium carbonate 1 Gm 3 times a day along with weekly cholecalciferol 60,000 IU for immediately for postoperative hypoparathyroidism. Her CD4 and CD8 counts were 756 cells/mm 3 and 819 cells/mm 3 , respectively and the viral load was 136 copies/ml. Diagnosis of LTNP-HIV infection was considered as per the current criteria of LTNP-HIV.


   Discussion Top


HIV-1 infection is common viral infection in India. There are subsets of HIV-1 infection in which the viral load is not very high, T cell subpopulations (helper/suppressor) cells are slightly reduced and patients can survive more than 8 years in the absence of antiretroviral therapy for HIV-1 infection. This subset is seen in only <1% of HIV-positive population. We considered LTNP-HIV infection rather than élite controller as the viral load was more than 100 HIV-RNA copies/ml and helper T cell count was stable over the past 10 years, in the absence of antiretroviral therapy in this case study. The diagnostic criteria of LTNP-HIV include: (i) Helper cell population (CD4 cells) more than 500 cells/mm 3 (ii) viral load <1000 copies/ml (iii) stable disease over a period of 8 years without antiretroviral therapy for HIV infection. Prevalence of LTNP is <1% of HIV-positive patients in clinical practice. [1] Most of the patients are asymptomatic.

Incidence of cancers either AIDS-defining cancers (ADCs) or non-AIDS-defining cancers (NADCs) in LTNP-HIV infection has not been reported earlier. Prevalence of cervical lesions in LTNP-HIV patients was studied in Africa. [2] Thyroid involvement in HIV-positive patients may have variety of causes. It may be involved due to infections or there could be drug-related thyroid dysfunction in HIV infection, [3] but primary malignancy of thyroid in LTNP-HIV-1 patients is not known. Etiology of the NADCs and ADCs is not well understood. Most of the patients with AIDS-associated cancers have viral etiology. Human papillomavirus is responsible for oral and cervical cancers, Epstein-Barr virus is related to non-Hodgkin's lymphoma (NHL) and human herpes virus 8 for Kaposi's sarcoma (KS). No such viral etiology is attributed in the pathogenesis of thyroid malignancy. [4]

HIV/AIDS-related cancers, either AIDS-defining malignancies (ADMs) or non-ADMs (NADMs) are often seen in HIV infection with advanced stage. With highly active antiretroviral therapy, the prevalence of KS and NHL has declined significantly. Thyroid cancers in HIV/AIDS are an uncommon and unusual type of NADM. [5] Mbulaiteye et al. reported rising incidence of cancers of thyroid, kidney, and uterus and of conjunctiva in HIV/AIDS in Africa. [6] Whether genetic factor(s) play any role in the pathogenesis of thyroid cancers in HIV-positive patients is not clear. [4] Papillary thyroid carcinoma [7] and medullary thyroid carcinoma [8] were reported in advanced HIV positive patients. They were receiving antiretroviral therapy for HIV infection unlike our patient.

Pathogenesis of LTNP-HIV infection is a mystery. Viral, genetic and host-related factors have been postulated in the development of LTNP-HIV infection. Patients with HIV-1 infection progress if they have abnormalities of nef gene or have high level of beta-2-microglobulin. While some genes protect against the progression. [1] CCR5 is a co-receptor for transmission of HIV-1 infection. Mutation of CCR5 gene is the most common abnormality in LTNP-HIV. Such mutation can be seen in Indian families as well. [9] Usually, individuals with homozygous delta 32 allele are resistant to HIV infection in spite of multiple exposures to HIV-infected persons while those with heterozygous delta 32 mutation have lesser viral replication and slower progression of HIV infection. [10] We have not evaluated our patient for molecular markers. Until date, patient has got good quality life following total thyroidectomy. How long will she remain LTNP-HIV or will she progress in future is not known.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kumar P. Long term non-progressor (LTNP) HIV infection. Indian J Med Res 2013;138:291-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
McLeod KE, Omar T, Tiemessen CT, Tshabangu N, Martinson NA. Prevalence of premalignant cervical lesions in women with a long-term nonprogressor or HIV controller phenotype. J Acquir Immune Defic Syndr 2014;65:e29-32.  Back to cited text no. 2
    
3.
Hoffmann CJ, Brown TT. Thyroid function abnormalities in HIV-infected patients. Clin Infect Dis 2007;45:488-94.  Back to cited text no. 3
    
4.
Vogel M, Friedrich O, Lüchters G, Holleczek B, Wasmuth JC, Anadol E, et al. Cancer risk in HIV-infected individuals on HAART is largely attributed to oncogenic infections and state of immunocompetence. Eur J Med Res 2011;16:101-7.  Back to cited text no. 4
    
5.
Santos J, Palacios R, Ruiz J, González M, Márquez M. Unusual malignant tumours in patients with HIV infection. Int J STD AIDS 2002;13:674-6.  Back to cited text no. 5
    
6.
Mbulaiteye SM, Katabira ET, Wabinga H, Parkin DM, Virgo P, Ochai R, et al. Spectrum of cancers among HIV-infected persons in Africa: The Uganda AIDS-Cancer Registry Match Study. Int J Cancer 2006;118:985-90.  Back to cited text no. 6
    
7.
Lloret Linares C, Troisvallets D, Sellier P, Aurengo A, Leenhardt L. Micrometastasis of papillary thyroid carcinoma in a human immunodeficiency virus-infected patient: A case report and discussion. Med Oncol 2010;27:756-9.  Back to cited text no. 7
    
8.
Metin I, Asena G, Kadri A. Thyroid medullary carcinoma in a patient with HIV/AIDS. Int J Hematol Oncol 2012;22:192-4.  Back to cited text no. 8
    
9.
Husain S, Goila R, Shahi S, Banerja AC. Inheritance pattern of mutant human immunodeficiency virus type 1 coreceptor gene CCR5 in an Indian family. J Hum Virol 1998;1:187-92.  Back to cited text no. 9
    
10.
Estrada-Aguirre JA, Cázarez-Salazar SG, Ochoa-Ramírez LA, Acosta-Cota Sde J, Zamora-Gómez R, Najar-Reyes GM, et al. Protective effect of CCR5 Delta-32 allele against HIV-1 in Mexican women. Curr HIV Res 2013;11:506-10.  Back to cited text no. 10
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
 

    

 
  Search
 
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (955 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1195    
    Printed19    
    Emailed0    
    PDF Downloaded35    
    Comments [Add]    

Recommend this journal