when compared with the general population , the incidence of acute myeloid leukemia in hiv - infected patients is increased approximately twofold . however , occurrence of acute promyelocytic leukemia ( apl ) has so far been reported in only five hiv - infected patients [ 1 - 4 ] . here , we report a case of an hiv - patient who developed apl and upon treatment entered a complete remission . a 25-year - old bisexual , caucasian male patient was diagnosed with hiv infection in 1996 . he was still antiretroviral nave in april 2004 when primary central nervous system lymphoma ( pcnsl ) was diagnosed by brain biopsy . we treated the patient with haart ( highly active antiretroviral treatment ) consisting of zidovudine , lamivudine and lopinavir / ritonavir , and whole brain irradiation with 46 gy . the therapy resulted in durable remission of the lymphoma . before we started with haart , the patients cd4 cell count was 7 cells / mmand his plasma hiv-1 rna was 329.000 copies / ml . thirty months later , in october 2006 , patient 's wbc was 1,6  10/l , hemoglobin level 109 bone marrow aspiration revealed massive infiltration of blasts , morphologically described as promyelocytes , and expressed the immunophenotypic markers of aberrant promyelocytic clone ( cd15-cd117+cd34-hld - dr- ) . fish analysis of the bone marrow aspirate showed chromosomal translocation specific for apl , t(15;17 ) , and cytogenetic analysis failed . pcr analysis detected an atypical pml / rar rearrangement of 470 bp , which was confirmed by gene sequencing . patient 's cd4 cell count was 184 cells / mmand the plasma hiv-1 rna viral load was < 50 copies / ml . in november 2006 induction therapy consisted of all - trans retinoic acid ( atra ) in dose of 45 mg / m / day taken orally for 34 days , and idarubicine in dose 12 mg / m / day intravenously through 4 days . during neutropenia treatment was complicated by sepsis . however , signs suggestive of the apl differentiation syndrome ( atra syndrome or retinoic acid syndrome ) such as pulmonary infiltrates or leukocytosis were not observed . because of pancytopenia and the poor general condition of the patient , we interrupted haart for a period of two months . a decrease of cd4 cell count to 47 cells / mmand increase of plasma hiv-1 viral load to 394.000 copies / ml was observed in december 2006 . haart with stavudine , lamivudine and lopinavir / ritonavir was started on december 28 , 2006 . in february 2007 , analysis of bone marrow aspirate and pcr analysis for the pml / rar indicated complete molecular remission . given the patients poor compliance along with severe side - effects of earlier treatments and low performance status , we decided to continue consolidation treatment with solely atra . atra was given during march and april 2007 as two cycles of 45 mg / m / day for 42 days . in november 2007 , we confirmed a sustained complete molecular remission . on the last follow - up in april 2008 , the patient was still in complete hematological remission , and no signs of pcnsl were observed either . the course of antiretroviral treatment , chemotherapy for apl , cd4 cell counts and viral load measurements are summarized in figure 1 . the course of antiretroviral therapy , chemotherapy , cd4 cells counts and viral load measurements over time . however , a subgroup of patients has been described that developed apl following various chemotherapy - or radio therapy - treated malignancies . an atypical pml / rar rearrangement found in our patient , and the fact that apl occurred 30 months after pcnsl , in a time frame characteristic for treatment - related apl , indicates that apl might have developed secondary to treatment of pcnsl . however , due to only five reported cases , the prognosis and course of apl in hiv - infected patients are unclear . in those reported cases , patient treated with the combined therapy of atra and chemotherapy entered a remission [ 1 - 5 ] . our patient achieved stable complete remission with induction therapy of atra and antracycline followed by reduced intensity consolidation therapy with atra , and concomitant haart . this therapy had acceptable side effects and induced a durable remission of apl in our patient , lasting for more than 14 months . atra treatment can be complicated by the apl differentiation syndrome and this diagnosis requires a high index of suspicion . the patient 's hiv-1 viral load increased transiently during interruption of haart , but reintroduction of therapy was soon followed by a good response ( figure 1 ) . based on evidence that atra can reduce hiv-1 viral load by acting as rt - inhibitor , we can speculate that it had additional positive impact in controlling hiv disease . in addition , the patient is in remission of pcnsl for more than 47 months , with no signs of major opportunistic disease and a good control of hiv plasma viral load . however , during this follow - up his cd4 cell count did not rise above 200/mm(figure 1 ) . in conclusion , we showed that atra and idarubicin based induction therapy followed by reduced intensity consolidation therapy can be applied successfully in patients with hiv - associated apl . however , the patient is still at a considerable risk for relapse and , whenever possible , standard treatment for apl together with haart should be used in hiv infected patients .
the occurrence of acute promyelocytic leukemia ( apl ) in hiv - infected patients has been reported in only five cases . due to a very small number of reported hiv / apl patients who have been treated with different therapies with the variable outcome , 
 the prognosis of apl in the setting of the hiv - infection is unclear . here 
 , we report a case of an hiv - patient who developed apl and upon treatment entered a complete remission . 
 a 25-years old male patient was diagnosed with hiv - infection in 1996 , but remained untreated . in 2004 , 
 the patient was diagnosed with primary central nervous system lymphoma . 
 we treated the patient with antiretroviral therapy and whole - brain irradiation , resulting in complete remission of the lymphoma . in 2006 , 
 prompted by a sudden neutropenia , we carried out a set of diagnostic procedures , revealing apl . 
 induction therapy consisted of standard treatment with all - trans - retinoic - acid ( atra ) and idarubicin . 
 subsequent cytological and molecular analysis of bone marrow demonstrated complete hematological and molecular remission . due to the poor general condition , 
 consolidation treatment with atra was given in march and april 2007 . 
 the last follow - up 14 months later , showed sustained molecular apl remission . in conclusion , we demonstrated that a complete molecular apl remission in an hiv - patient was achieved by using reduced - intensity treatment .