Effect of Radiation Therapy to Immunological and Virological Status in HIV/AIDS-Cancer Patients, Preliminary Report
Pathomphorn Siraprapasiri MD*, Ekkasit Tharavichitkul MD**, Nan Suntornpong MD***, Chowkaew Tovanabutra MD****, Thanomsak Anekthananon MD***, Ekapop Meennuch MD*****, Thapana Tangshevinsirikul MD****
Affiliation : * Division of Therapeutic Radiology and Oncology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand ** Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *** Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand **** Chonburi Cancer Center, Chonburi, Thailand ***** Maha Vajiralongkorn Cancer Center, Thanyaburi, Pathumtani, Thailand
Objective : To describe effects of radiation therapy (RT) on immunological status (CD4 cell counts) and disease progression
among HIV-positive cancer patients.
Material and Method: This prospective observational study was conducted among HIV-positive cancer patients who
received RT for curative intention of cancer in five selected hospitals in Thailand. All subjects received external beam
radiation therapy, according to standard clinical practice guidelines of RT. Blood samples were taken 4 times for complete
blood count, CD4 cell count and plasma HIV RNA viral load (HIV-VL) assays before and in the last week of RT, then three and
six months after completion of RT.
Results : This preliminary study reported immunological status and HIV-VL before and the last week of RT, among 29 HIV-
positive female cancer patients enrolled from August 22, 2009 to June 30, 2010. The median age was 38 years (range 30-54).
27 patients (93 percent) had invasive cervical cancer. 26 patients (90 percent) were on antiretroviral treatment (ART). The
mean baseline white blood cell (WBC) count, lymphocyte percentage were 6,771.7 cells/μL and 31.7 percent respectively. The
mean baseline CD4 cell count and CD4%, 387.8 cells/μL and 17.5 percent respectively. In the last week of RT, 25 subjects
(86 percent) had CD4 count less than 200 cells/μL. The last week, mean WBC count, and mean lymphocyte percentage
decreased to 3,902.8 cells/μL and 17.5 percent respectively. Mean CD4 count number decreased to 157.7 cells/μL, but the
mean CD4 % did not change. Four patients (14 percent) had increased HIV-VL after RT, of these two were not on ART and
two were on ART for more than 1 year.
Conclusion : The CD4 cell count was not a good surrogate for prediction of immunologic status of HIV-positive cancer
patients during RT.
Keywords : Cancer, Observational study, Radiation therapy, HIV, AIDS, CD4
