Malignant solid tumour, HIV infection and tuberculosis in children: an unholy triad

Co-morbidities introduce confounding variables into investigational protocols and complicate both diagnosis and management of children with malignant solid tumours. Such patients who are coincidentally HIV infected and who also have pulmonary or abdominal tuberculosis pose a particular challenge. The purpose of this report is to describe the diagnostic and management difficulties encountered in a small cadre of 18 HIV-infected children with solid tumours presenting to the Department of Paediatric Surgery. A retrospective descriptive study of HIV-infected children with malignant solid tumours. 18 HIV-infected children were identified with a variety of primary tumours. 11 children had confirmed pulmonary or abdominal tuberculosis and in 4 the diagnosis was suspected. Neoadjuvant chemotherapy was used when possible to provide a window of opportunity to investigate co-morbidity and improve health status, inter alia, improving the patients' nutritional status. FDG-PET scanning proved unreliable in discriminating between malignant and inflammatory pathology. Overall survival was 33%. The coincidence of malignancy, HIV infection and tuberculosis carries a high mortality independent of the primary tumour type.