Profile of Mortality Among Women With Gestational Trophoblastic Disease Infected With the Human Immunodeficiency Virus (HIV): Argument for a New Poor Prognostic Factor

Abstract

Gestational trophoblastic disease (GTD) encompasses a spectrum of conditions ranging from hydatidiform mole to choriocarcinoma. The management of GTD in association with human immunodeficiency virus (HIV) infection is complicated by the interaction between chemotherapy, antiretroviral therapy, and poor performance status due to HIV-related illnesses. This study describes the profile of mortality of women with GTD in the background of HIV infection. A total of 78 patients with GTD were reviewed retrospectively. There were 53 patients with invasive molar pregnancy and 23 patients with choriocarcinoma. The HIV seroprevalence was 31%. There were 15 deaths (19%). There were 8 HIV-infected (33%) and 7 HIV noninfected (13%) who demised. Of the 8 patients with CD4 counts less than 200 cells/μL, 7 patients demised. There were no mortalities among patients with CD4 counts more than 200 cells/μL. Of the 15 deaths, 5 HIV-infected patients and 5 HIV-noninfected patients received chemotherapy. There were 5 patients admitted in very poor general condition precluding the administration of chemotherapy. Among the 10 patients that received chemotherapy and demised, the causes of death included widespread disease, multiorgan failure, and toxicity due to chemotherapy. These findings highlight the poor outcomes of HIV-infected women with CD4 counts less than 200 cells/μL due to poor tolerance to chemotherapy or poor performance status precluding administration of chemotherapy.