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CML patient with HIV+ status

  • Jeff Lipton
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10 years 4 days ago #775 by Jeff Lipton
CML patient with HIV+ status was created by Jeff Lipton
New CML patient who is HIV positive and seems well controlled with good CD4 levels. Does anyone have any experience in this area? Any preference for TKI or dosing, given the drug interactions?
  • Tim Hughes
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10 years 4 days ago #776 by Tim Hughes
Replied by Tim Hughes on topic Re: CML patient with HIV+ status
I have only had one HIV positive CML patient. They were diagnosed with both HIV and CML in the nineties and went through interferon, imatinib, and nilotinib before developing BC about 15 years after diagnosis. Drug compliance was an issue, but there was no activation of the HIV, despite all of these therapies. I would be interested in others experience here.

I would tend to favour imatinib frontline in this setting because of concerns about drug interactions, vascular toxicity (HIV is apparently a risk factor for vascular disease) and immune dysregulation with the second generation drugs.
  • Jorge Cortes
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10 years 4 days ago #777 by Jorge Cortes
Replied by Jorge Cortes on topic Re: CML patient with HIV+ status
The few I have treated I have used imatinib full dose with no problems.
  • Michael Mauro
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10 years 4 days ago #778 by Michael Mauro
Replied by Michael Mauro on topic Re: CML patient with HIV+ status
Whilst I haven’t had any CML patients who were also HIV+, I would favor IM for similar reasons as Tim
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10 years 4 days ago #779 by fcervantes
I have treated two such patients with imatinib with good response and no problem of toxicity other than the usua one.
  • Mhairi Copland
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10 years 3 days ago #780 by Mhairi Copland
Replied by Mhairi Copland on topic Re: CML patient with HIV+ status
We have treated 2 HIV positive patients. One continues on imatinib but has struggled with haematological toxicity and is on a reduced dose (from the Far East) and a second that failed imatinib, but has done very well on dasatinib. Both now have undetectable transcripts. I would favour imatinib first line in these patients.
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