NEW YORK (Reuters Health) - HIV-infected men face a significantly higher risk of testicular seminoma than do age-matched HIV-negative men, according to a report in the May 15th Journal of Clinical Oncology.

HIV infection is associated with a number of malignancies, the authors explain, but the link between HIV infection and germ cell tumors remains controversial.

Dr. Mark Bower from Chelsea & Westminster Hospital in London and associates examined the clinical history of testicular germ cell tumors (GCT) in 35 HIV-positive men from 6 European HIV treatment centers.

Based on the identification of GCT in 14 patients among a prospective cohort of 8640 HIV-positive patients, the authors calculated the HIV-related GCT incidence as 3.32 cases per 100,000 male patient years of follow-up, a rate significantly higher than the 0.76 cases per 100,000 male patient years in a matched population of HIV-negative men in southeast England.

This incidence results in a 4.36-fold increased risk of GCT among HIV-positive men, the report indicates, with virtually all of the risk attributable to the 5.45-fold increased risk of seminoma. The incidence of nonseminoma GCT was similar between HIV-infected and HIV-negative men.

The incidence of GCT was similar before and after the availability of highly active antiretroviral therapy (HAART), the results indicate.

Only one of nine patients with metastatic seminoma died, the researchers note, and he had advanced HIV disease and refused active treatment for GCT. The sole patient who died with metastatic nonseminoma GCT also failed to comply with his chemotherapy regimen.

The overall 5-year survival is 79%, the results indicate, and the tumor-free survival after 5 years is 89%. Most of the deaths resulted from HIV-related disease, not from the GCT, and all of the deaths occurred in the pre-HAART era.

Chemotherapy decreased median CD4 cell counts by about 90 cells per microliter, the investigators report, whereas adjuvant radiotherapy decreased median counts by about 110 cells per microliter.

There is a "high incidence of GCT in HIV-positive men," Dr. Bower told Reuters Health. However, he said, his surveillance of HIV-infected patients would not differ at all from that of HIV-negative men after remission from GCT.

Similarly, Dr. Bower said he would not use any different criteria for dosing chemotherapy in HIV-infected patients being treated for GCT, but would be aware of potential interactions between protease inhibitors and the metabolism of cytotoxic drugs.

J Clin Oncol 2003; 21:1922-1927.

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