Human immunodeficiency virus Infection in a patient of chronic myelogenous leukemia
A 50-year-old male patient was a known case of diabetes mellitus and was being treated for that since 1989. He was; however, quite irregular with this treatment and his diabetes was often out of control.\nIn November 2005, he presented with complaints of fever, cough with expectoration and weakness. The fever was low grade and there was no history of hemoptysis, dysuria and hematuria. Routine laboratory investigations showed high White Blood Cell count which was 59,000/mm3, and there were premature leucocytes on peripheral smear. He also had elevated platelet count which was 726,000/mm3. His diabetes was out of control with FBS level 264 mg/dl and PPBS value 372 mg/dl.\nA provisional diagnosis of CML with uncontrolled diabetes mellitus was made and he was further investigated.\nHis routine urinalysis showed glycosuria. Renal Function Tests and Liver Function Tests were within normal limits. Test for HIV infection was non-reactive. Chest X-ray did not reveal any abnormality. Bone marrow aspiration study was consistent with the diagnosis of CML. Test for Philadelphia chromosome was not carried out.\nHe was given hydroxyurea 500 mg 3 times a day and subsequently the doses were titrated with reference to WBC count.\nDuring the follow-up that spanned over next several months, he experienced occasional seasonal attacks of respiratory infection. For this, he was treated with antibiotics and insulin which controlled the infection promptly.\nIn October 2010, he complained of occasional fever, cough with slight expectoration and loss of appetite, weakness and weight loss. He was diagnosed to have pulmonary tuberculosis on the basis of his clinical picture and positive TB ELISA test (IgM) for which he received anti tubercular treatment for next 10 months.\nIn February 2011, he complained of retrosternal burning sensation while walking which was relieved by rest. He also experienced tightness around the chest. The pain did not radiate but was associated with the mild breathlessness. ECG did not reveal any abnormality. The Treadmill Test was strongly positive for exercise induced coronary insufficiency.\nAs his symptoms and stress test suggested coronary heart disease, he was referred to a cardiac center for further evaluation. 2D-echo was carried out which showed echo-concentric LVH, normal resting systolic function, presence of diastolic dysfunction, no regional wall motion abnormalities, and normal PA pressure. Coronary angiography was done on 1st March 2011 which showed LVEF 50% and triple vessel disease. Revascularization was contemplated; however, his routine investigation showed a positive HIV test; hence no further interventional treatment was carried out.\nThis new development necessitated further investigations. Philadelphia chromosome was tested which showed a positive result. CD3, CD4 and CD8 count results were 2940 cells/mm3, 393 cells/mm3 and 2477 cells/mm3 respectively. Viral load was tested on 5th November 2011and it showed 43356 HIV-1 RNA copies/ml.\nHe was advised to start anti-retroviral therapy along with Imatinib, however, patient declined to take this treatment due to lack of resources. He was therefore continued on hydroxyurea.\nIn May 2012, the retroviral disease tests were repeated. The results of both the tests are given in .\nPatient continues to take hydroxyurea regularly and in spite of advanced HIV he has not developed any major complications of HIV or CML during his follow-up period.