Challenges to treatment of leukemia in HIV-positive children.

We describe the challenges to treatment of leukemia in three cases of human immunodeficiency virus (HIV)-infected children with multiple infections and complications. Two of the three patients had acute myeloid leukemia and the other one acute lymphoblastic leukemia. Two of the patients were known with HIV infection; the third was diagnosed on admission. All patients received antiretroviral therapy with standard doses of lamivudine, stavudine and efavirenz or lopinavir/retonavir. All three were diagnosed with Mycobacterium tuberculosis on one or more occasions: pulmonary or miliary involvement or tuberculous meningitis. One patient developed spinal paraplegia and needed an urgent laminectomy. Later he recovered almost completely. The interaction between antiretroviral and antituberculosis treatments combined with chemotherapy, antibiotics and supportive care is not known. Despite the severity and the complexity of several associated diseases, the outcome of the patients was rewarding and encouraging.

A review of the use of blood and blood products in HIV-infected patients.

Despite numerous publications on the appropriate use of blood and blood products, few specifically consider the role of transfusion in the management of HIV. This review is a synthesis of conditions encountered in the management of HIV-infected patients where the transfusion of blood or blood products may be indicated. A consistent message emerging from the review is that the principles of transfusion medicine do not differ between HIV-negative and -positive patients. The aim of the review is to provide clinicians with a practical and succinct overview of the haematological abnormalities and clinical circumstances most commonly encountered in the HIV setting, while focusing on the rational and appropriate use of blood and blood products for HIV patients. Important ethical considerations in dealing with both the collection and transfusion blood and blood products in the HIV era have also been addressed.

Ethnicity and characteristics of Hodgkin lymphoma in children.

AIM: To identify ethnic group differences in the prognostic of Hodgkin lymphoma (HL) in South African children. PATIENTS AND METHODS: In order to create a larger database, cases were pooled from two South African hospitals: Tygerberg in the Western Cape and Bloemfontein Academic Complex in Free State. Self-assigned ethnicity was used to allocate the children to the following groups: black, white, and colored (historical descendants of couples of distinct ethnicity, the "Cape colored" are the largest population group in Western Cape). Retrospective data over 21 years were obtained from the tumor registry. Age at presentation, sex, ethnic group, stage, histological type, treatment protocol, event-free survival interval, and mortality were analyzed. The statistical significance of the findings was tested using the chi-square, Mann-Whitney U, and Kruskal-Wallis tests, as indicated. RESULTS: The study population of 138 comprised 78 black (56.5%), 38 colored (27.5%), and 22 white (16%) children under 15 years of age. There was a 3:1 predominance of the male gender. The median age at diagnosis was 8 years 11 months. Black patients presented at the youngest age (median 103 months), whereas white patients were the oldest at presentation (median age 133 months; P = 0.04).Forty-five percent of all patients were seen in stage 2. Black and colored patients presented with significantly more advanced stage disease (P = 0.04) than whites. B symptoms were evenly distributed among ethnic groups; they increased the mortality ratio from 10% to 33% (P = 0.0019). Histologically, mixed cellularity was seen in 50% of the black children, while nodular sclerosis was found in 50% of whites. The overall survival rate is 79%, with 68% in whites, 84% in patients of mixed ethnicity, and 79% in blacks (P = 0.35). CONCLUSIONS: White children had the worst HL prognosis in this series, in spite of a less advanced stage at presentation.