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.