Patients with HIV, cancer less likely to receive oncology treatment

Among those with cancer, patients with HIV were less likely to receive cancer treatment than patients without HIV, according to data published in the Journal of Clinical Oncology.

“When we focused only on early-stage cancers that have the highest chance of cure with appropriate treatment, the differences in cancer treatment were great,” Gita Suneja, MD, assistant professor in the department of radiation oncology at the University of Utah, Huntsman Cancer Center told Infectious Disease News. “We need to understand what factors are driving the differences in treatment and address them. This is particularly important as cancer is becoming increasingly common in the HIV population.”

Gita Suneja, MD 

Gita Suneja

Suneja, who is also an adjunct assistant professor in the department of radiation oncology at the University of Pennsylvania, and colleagues from the National Cancer Institute, identified adults with cancer using cancer registries in Connecticut, Michigan and Texas and ascertained the patients’ HIV status using linked HIV registries. The patients were diagnosed between 1996 and 2010 with non-Hodgkin’s lymphoma or cervical cancer (AIDS-defining cancers) or non-AIDS-defining cancers, including Hodgkin’s lymphoma or lung, anal, prostate, colorectal and breast cancers.

The study included 3,045 patients with HIV and 1,087,648 patients without HIV. The most common cancers in the patients with HIV included diffuse large B-cell lymphoma (DLBCL), lung cancer and anal cancer, whereas in patients without HIV, the most common cancers were prostate, breast and lung cancers.

For DLBCL, lung cancer, Hodgkin’s lymphoma, prostate cancer and colorectal cancer, a significantly higher proportion of patients with HIV did not receive cancer treatment compared with patients without HIV. The associations for cervical and breast cancer were not significant and treatment for anal cancer was the same in both patients with and without HIV.

Among patients with HIV, predictors of a lack of cancer treatment included distant and unknown cancer stages, men with HIV exposure by IV drug use, age 45 to 64 years, black race and CD4 counts lower than or equal to the median of 144 cells/mcL.

Suneja said that there is uncertainty surrounding the treatment of patients with HIV who have cancer, as these patients have historically been excluded from clinical trials. As a result, oncologists may not know if the best available treatments are equally safe and effective in patients with HIV.

“Many oncologists rely on guidelines based on clinical trials to make treatment decisions, and in the absence of guidance, they may elect not to treat HIV-infected cancer patients due to concerns about adverse effects or poor survival,” Suneja said. “We hope that the findings of this study raise awareness of cancer treatment disparities in HIV-infected cancer patients among patients, providers and policy makers.

Suneja suggested patients with HIV and cancer be comanaged by oncologists and HIV specialists to ensure that treatment is safely delivered and that clinical trials of cancer therapy should no longer exclude patients with well-controlled HIV. She also said cancer management guidelines should incorporate information specific to patients with HIV, where appropriate. — by Emily Shafer

Gita Suneja, MD, can be reached at gita.suneja@icloud.com.

Disclosure: Suneja reports no financial disclosures.

Perspective
Paul A. Volberding, MD

Paul A. Volberding

  • We recognize that HIV infection makes some cancers — especially those associated with a second viral infection — more common. Some of these are relatively common in the United States and one of these, anal cancer, has been the subject of substantial research interest. Cancers that are not AIDS-defining may be more or less common in people with HIV, but are more frequently diagnosed as that large population ages thanks to the benefits of current antiretroviral therapy. Optimum health outcomes for that aging population will increasingly require excellent collaboration between HIV clinicians and other specialists. This may particularly be the case with oncology, where concerns of drug interactions and toxicity are complex. As this paper suggests, we have work to do to improve this collaboration. HIV care today can allow fully mainstream cancer care. It is of interest that cancer outcomes in anal malignancy was unaffected by HIV infection. This may well be linked to the ongoing research investment in that condition. We might hope for similar improvements in other cancers among people with HIV, which are also a focus for clinical investigation.

    • Paul A. Volberding, MD
    • Infectious Disease News Chief Medical Editor
  • Disclosures: Volberding reports no relevant financial disclosures.