Patients with HIV-related testicular cancer have a similar cancer-free outcome compared to their HIV-negative counterparts if treated in an identical manner in the HAART era . This contradicts early reports in the pre-HAART era . Diagnosis should follow an identical path regardless of HIV status and all patients should be tested for HIV infection. A testicular mass must be treated with the utmost suspicion Torin 1 nmr and an ultrasound scan (or MRI) and tumour markers (AFP, HCG) should follow. LDH is nonspecific and should only be used to prognosticate patients with metastatic
disease. False-positive AFP can be related to HAART/hepatitis-related liver disease, while there are many causes of a false positive LDH . The differential diagnosis for a testicular mass in this setting includes orchitis and lymphoma. A CT scan of the chest abdomen and pelvis should be performed for full staging. MRI scanning for para-aortic lymph nodes is an alternative for the abdomen and pelvis. There is no clear role for FDG-PET in these patients regardless of HIV serostatus. Patients with stage I disease (seminomas or NSGCT) can be safely treated with surveillance alone selleck and have a similar outcome to their HIV-negative counterparts . Alternatively, adjuvant carboplatin (AUC7) can be offered to the seminoma patients (we advise one cycle), while two cycles of adjuvant BEP can be offered to the NSGCT . It appears three
cycles of BEP suppresses the CD4 cell count by between 25 and 50%, and it is probable that two cycles of BEP will also be suppressive. Therefore low-risk NSGCT patients should be offered surveillance and adjuvant therapy should only be considered for high-risk NSGCT . Additionally it has been suggested that adjuvant therapy should be considered in patients with a haphazard lifestyle (who are unlikely to co-operate with an intensive surveillance programme) . Patients should receive HAART during adjuvant or metastatic chemotherapy . Prophylactic antifungal agents should be considered, especially for patients receiving two cycles of
BEP . Patients should be risk stratified according to the IGCCCG guidelines in an identical manner to HIV-negative Sclareol patients . Good-risk patients should be offered three cycles of standard 5-day BEP with concurrent HAART and prophylactic antifungals should be considered [1,6]. One should expect a 50% drop in the CD4 cell count with chemotherapy [6,9]. Treatment modifications should follow the HIV-negative model. Those with extensive pulmonary limitation from previous infection can alternatively have four cycles of EP chemotherapy . Carboplatin should not be used as a substitute for cisplatin and dose modifications/delays should be avoided where possible. Growth factors such as G-CSF should be considered where appropriate . Patients with intermediate- and poor-risk disease should be offered four cycles of standard 5-day BEP chemotherapy [1,6].