HIV-positive people with early-stage cancer up to four times more likely to go untreated for cancer

June 30, 2014

HIV-infected people diagnosed with cancer are two to four times more likely to go untreated for their cancer compared to uninfected cancer patients, according to a new, large retrospective study from researchers in Penn Medicine's Abramson Cancer Center and the National Cancer Institute (NCI) published online ahead of print in the Journal of Clinical Oncology.

Life expectancy for HIV-infected people is now similar to uninfected people, but survival for HIV patients who develop is not. While many studies have attempted to understand why HIV-infected have worse outcomes, the new study, the largest of its size and scope, examined differences in cancer treatment as one potential explanation. For early-stage cancers that have the highest chance of cure with appropriate treatment, those with HIV were twice to four times as likely to not receive appropriate cancer treatment, the researchers found. HIV-infected people with lymphoma, lung cancer, prostate cancer, and colorectal cancer were almost twice as likely to be untreated for cancer, even after considering differences in age, gender, race, and stage.

"In my clinical experience, I have seen uncertainty surrounding treatment of HIV-infected cancer patients," said the study's lead author, Gita Suneja, MD, an adjunct assistant professor in the department of Radiation Oncology at the Perelman School of Medicine at the University of Pennsylvania and in the Abramson Cancer Center. "Patients with HIV have typically been excluded from clinical trials, and therefore oncologists do not know if the best available treatments are equally safe and effective in those with HIV. Many oncologists rely on guidelines based on such trials for treatment decision making, and in the absence of guidance, they may elect not to treat HIV-infected cancer patients due to concerns about adverse side effects or poor survival."

"This could help explain in part why many HIV-positive cancer patients are not receiving appropriate cancer care," she added.

Dr. Suneja collaborated with researchers at the NCI, as well as registrars from three states—Connecticut, Michigan, and Texas—that provided data to NCI's HIV/AIDS Cancer Match Study. The researchers used the data to study adults diagnosed with non-Hodgkin lymphoma, Hodgkin lymphoma, or cervical, lung, anal, prostate, colorectal, or breast cancer from 1996 through 2010. Over 3,000 HIV-infected and one million uninfected cancer cases were examined.

The advent of antiretroviral therapy has changed the outlook in the fight against HIV/AIDS. People with HIV are living longer and healthier lives, and a disease that was once thought to be universally fatal has now become a chronic and manageable disease like diabetes or hypertension.

In the early era of the HIV epidemic there were reports of worse toxicity and side effects, but there are now more effective ways to support the immune system, most of them safe, tolerable and effective. Still, treatments for cancer patients with HIV can be clinically challenging due to drug interactions and the potential increase in immunosuppression from chemotherapy or radiation.

To help close the disparity gap among HIV positive patients with cancer and those not infected, should begin enrolling HIV-infected patients, the authors suggest, and cancer management guidelines should incorporate recommendations for HIV-infected patients.

"The results of this study are very concerning and require further investigation to understand why such a substantial proportion of HIV-infected cancer patients are not undergoing life-saving treatment," said Dr. Suneja. "As cancer becomes an increasingly common cause of death in the HIV population, the issue of in the HIV-infected cancer population will grow in importance."

Explore further: Hepatitis C reactivation doesn't worsen survival for HIV+ patients diagnosed with lymphoma

Related Stories

Hepatitis C reactivation doesn't worsen survival for HIV+ patients diagnosed with lymphoma

May 30, 2014
More than a quarter of HIV+ patients are also infected with the Hepatitis C virus (HCV), which may complicate treatment and care decisions after a cancer diagnosis. The specifics of those complications haven't been well-researched ...

HIV helps explain rise of anal cancer in US males

October 6, 2012
The increase in anal cancer incidence in the U.S. between 1980 and 2005 was greatly influenced by HIV infections in males, but not females, according to a study published October 5 in the Journal of the National Cancer Institute.

HIV no barrier to getting liver transplant, study finds

May 17, 2013
(HealthDay)—Liver transplants to treat a common type of liver cancer are a viable option for people infected with HIV, according to new research.

HIV raises anal cancer risk in women, study says

April 16, 2012
(HealthDay) -- Women with HIV are at increased risk for anal cancer, a new study finds.

Increased anal cancer risk from HIV plus HPV dual infection

December 3, 2013
(Medical Xpress)—Human papillomavirus, or HPV, which can cause cervical cancer in women, is also known to cause anal cancer in both women and men. Now, a study led by researchers at the UCLA School of Nursing has found ...

Standard treatments for head and neck cancer less effective in HIV-positive patients

January 26, 2012
Radiation therapy with or without chemotherapy is less effective for patients with HIV when compared to the recurrence and overall survival rates in patients who do not have HIV, according to a study presented at the Multidisciplinary ...

Recommended for you

Scientists divulge latest in HIV prevention

July 25, 2017
A far cry from the 1990s "ABC" campaign promoting abstinence and monogamy as HIV protection, scientists reported on new approaches Tuesday allowing people to have all the safe sex they want.

Girl's HIV infection seems under control without AIDS drugs

July 24, 2017
A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines—more evidence that early treatment can occasionally cause a long remission that, ...

Meds by monthly injection might revolutionize HIV care (Update)

July 24, 2017
Getting a shot of medication to control HIV every month or two instead of having to take pills every day could transform the way the virus is kept at bay.

Candidate AIDS vaccine passes early test

July 24, 2017
The three-decade-old quest for an AIDS vaccine received a shot of hope Monday when developers announced that a prototype triggered the immune system in an early phase of human trials.

Paris spotlight on latest in AIDS science

July 21, 2017
Some 6,000 HIV experts gather in Paris from Sunday to report advances in AIDS science as fading hopes of finding a cure push research into new fields.

Scientists elicit broadly neutralizing antibodies to HIV in calves

July 20, 2017
Scientists supported by the National Institutes of Health have achieved a significant step forward, eliciting broadly neutralizing antibodies (bNAbs) to HIV by immunizing calves. The findings offer insights for HIV vaccine ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.