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P35 Are testicular mixed germ cell tumours associated with hepatitis C(HCV) in HIV infected men who have sex with men?
  1. David Atefi,
  2. Daniel Richardson
  1. BSUH NHS Trust, Brighton, UK

Abstract

Background/introduction HCV infection and testicular germ-cell tumours are indicator diseases for HIV-testing in BASHH-guidelines. There is little data on the association of testicular tumours in MSM with HIV.

Aim(s)/objectives We describe 2 MSM with treated HIV-Hepatitis C co-infection who were both subsequently diagnosed with mixed-germ-cell testicular tumours.

Case details Patient-1 is a 51-year-old MSM, diagnosed with HIV in 2004 on Atripla since 2010. In May 2012, routine ALT = 186 and positive HCV-RNA (genotype 1). This was treated with 48-weeks of pegylated-interferon/ribavirin. He had a sustained-viral-response (SVR). Two years later, he presented to the STI-clinic with a four month history of testicular swelling. Ultrasound showed this to be likely malignant infiltration, AFP = 2484, LDH = 426, HCG = 5.9. After orchidectomy, histology demonstrated mixed germ cell tumour. He is in clinical/radiological remission. Patient-2 is a 41-year-old MSM diagnosed with HIV in 2004. In 2007 he received IL-2 in a clinical trial. In both 2008 and 2012 routine ALT = 918,505 respectively and HCV-RNA was positive (genotype 2/3)(genotype 1). HCV was treated with pegylated-interferon/ribavirin both times with SVR. Anti-retrovirals (Atripla) were started in 2012. That year, he presented with an E-Coli-UTI and testicular swelling. Ultrasound/orchidectomy found a mixed germ cell testicular tumour. Tumour markers were AFP = 16.5, LDH = 376, HCG = 16.5. He was treated with orchidectomy, bleomycin/etoposide/cisplatin and is in radiological/clinical remission.

Discussion/conclusion HIV infection and hepatitis C treatment are immunosuppressive and are potential causative factors in these HIV-MSM testicular germ-cell tumours. Early investigation of testicular swellings in men with HIV-Hepatitis C is important.

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