People who suffered through the advanced stages of AIDS were often shunned because of the presence of unsightly reddish-purple lesions—but lesions are a direct manifestation of cancer, not AIDS, and in 2018 cancer is still a common problem among people living with HIV.
The National Comprehensive Cancer Network (NCCN) released new NCCN Clinical Practice Guidelines in Oncology in an effort to help make sure people living with HIV who are diagnosed with cancer receive the proper treatment.
Cancer, sadly, is inexorably intertwined with HIV. Many of us remember the very visible effects from people in the advanced stages of AIDS who were (and still are) afflicted with epidemic Kaposi sarcoma lesions—and it was considered an eyesore. It’s a cancer caused by Kaposi sarcoma associated herpesvirus that’s a result of a compromised immune system. The outlook for people who battle both diseases at the same time has never been promising.
Today cancer continues its unwelcomed persistent role in HIV progression. As recent as 2010, an estimated 7,760 Americans living with HIV were diagnosed with cancer, representing an approximately 50 percent higher rate than the general population. But despite the higher rate of cancer, people living with HIV received significantly lower rates of cancer-related care.
The numbers that reflect access to cancer treatment for people living with HIV are alarming, to say the least. People living with HIV are two-to-three times more likely to go without cancer treatment than non-infected individuals.
Dr. Suneja is Co-Chair of the NCCN Guidelines Panel for Cancer in People Living With HIV. “The disparity in cancer care is large and significant. For most cancers, people living with HIV are two-to-three times more likely to receive no cancer treatment compared to uninfected people,” Suneja stated in a press release. “Although we don’t yet know all the reasons for these large differences in cancer treatment, the lack of clinical management guidelines available to clinicians has been shown to be one contributing factor.”
It’s not only Kaposi sarcoma. In order of prevalence, the most common forms of cancer in people living with HIV are non-Hodgkin’s lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral or pharyngeal cancer, female breast cancer and cervical cancer.
Living a longer life, the researchers explain, is the end goal and the reason behind the new recommendations. “The ultimate goal is to improve cancer survival among people living with HIV,” said Dr. Suneja. “With modern antiretroviral therapy (ART), people with HIV are living longer and therefore getting more cancers related to both HIV infection and aging. The bottom line is that the cancer burden is growing—in fact cancer is quickly becoming the leading cause of death in people living with HIV—so we urgently need to improve cancer treatment in this population.”
The new NCCN Guidelines recommend that the same cancer therapies be made available to people living with HIV and HIV-negative people, regardless of status. They also call for care to be co-managed with an oncologist and an HIV specialist. The recommendations also call for HIV specialists and oncologists to review and be aware of drug-drug interactions and overlapping toxicity.
The reasons for the lack of cancer treatment in people living with HIV is not conclusively known, but overlapping toxicity may play a role in the reluctance of doctors to administer multiple medications at the same time.
“One of the most important points we want providers to be aware of surrounds the potential for drug interactions and overlapping toxicities between cancer therapeutics and ART,” said Erin Reid, MD, also Co-chair of the NCCN Guidelines Panel for Cancer in People Living With HIV. “Some antiretroviral-cancer therapeutic combinations have serious risk of increased toxicity, while others may reduce levels of either cancer therapeutics or the antiretroviral.” Reid explains that the good news is that with more antiretroviral combinations available, there is a better chance to minimize these risks by modifying antiretroviral therapy during cancer treatment.
We can all hope that the new NCCN Guidelines provide a better understanding of the cancer risks that are evident in people living with HIV, and better ways to make cancer treatment available for pe