People Living with Cancer and HIV Have Unique Needs

With a little help from Dr. Gita Suneja from Duke Cancer Institute in Durham, North Carolina, new guidelines have been established for people living with both cancer and HIV. The new guidelines were recently highlighted in the Duke Chronicle.

Twenty-seven cancer centers have allied together to form The National Comprehensive Care Network (NCCN). The network’s goal is to find the best possible preventive, diagnostic, treatment and supportive services for people battling cancer. Suneja and the NCCN have produced a new set of guidelines for people living with cancer and HIV.

Dr. Suneja is also 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,” said Gita Suneja, MD. “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.”

Back in 2014, data was released identifying that most people living with HIV don’t receive the proper care or prevention for cancer. This alarming research triggered Suneja and others to survey U.S. oncologists about shortcomings. Most were concerned about toxicity problems, and nearly all agreed that previous guidelines were insufficient. Later, Suneja and others would draft up new guidelines to help control the imbalance.

The guidelines cover a variety of cancer subtypes instead of focusing on one area. It includes drug-drug interactions and principles for HIV management during cancer treatment. Some guidelines are about specific cancer types like cervical cancer and Hodgkin's lymphoma.

Among the new guidelines are the following highlights:

Most people living with HIV who develop cancer should be offered the same cancer therapies as HIV-negative individuals.

Those living with HIV and cancer should be co-managed with an oncologist and an HIV specialist. Visit  locator.hiv.gov to find local specialists if you live in the United States.

Oncologists, HIV clinicians and pharmacists should closely monitor cancer therapy and ART for possible drug-drug interactions and overlapping toxicity concerns

Survival for everyone, obviously, is the end-goal. “The ultimate goal is to improve cancer survival among people living with HIV,” added 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.”

Dr. Erin Reid is Co-chair of the NCCN Guidelines Panel for Cancer in People Living with HIV and Vice-Chair of the AIDS Malignancy Consortium Lymphoma Working Group. Reid stressed that one of the most major concerns about people living with HIV and cancer is the increased risk of toxicity. Fortunately, some HIV drugs are beneficial for fighting not only HIV, but cancer as well.

For a refresher, in the early days of the virus, some people who were diagnosed with HIV were given the same exact drugs, i.e. AZT, that were originally developed for people fighting cancer.

In 2018, HIV is relatively controllable. Once people have HIV under control, they can focus on fighting cancer, if they are burdened by both diseases and depending on the severity and cancer subtype.