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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?
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.
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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