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Reduce stigma, improve education to increase cancer treatment among patients with HIV
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Infectious Disease News Chief Medical Editor Paul A. Volberding, MD, is a professor of medicine and director of the AIDS Research Institute at the University of California, San Francisco. He spoke with Healio about which types of cancer patients infected with HIV are more likely to develop, how effective HIV treatments have changed the risk for cancer, how cancer affects HIV treatment and how to increase cancer treatment among these patients.
Question: What types of cancer are patients infected with HIV at a greater risk for developing?
Answer: Kaposi sarcoma, non-Hodgkin lymphoma, central nervous system lymphoma and cervical cancer are the cancers that have been linked directly to HIV infection. The rates of those cancers are increased in patients with HIV, especially as they age. Patients living with HIV are starting to develop a variety of cancers that we are not sure are more common or earlier, but we are definitely seeing more cancers in our AIDS population.
Q: How has antiretroviral therapy changed the risk for cancer among people living with HIV?
A: Since the development and implementation of ART, we now see very few cases of Kaposi sarcoma anymore in patients who are being treated for their HIV and have their virus suppressed. We still see occasional cases, but usually in people who have been out of care.
Moreover, we now see rare cases of lymphoma and almost no cases of central nervous system lymphoma.
However, both cervical cancer and anal cancer are still common in patients with HIV. So, we still see some cancers – cervical and anal cancers have not seemed to have gone away quite as much as some of the others.
Q: How does the presence of cancer affect the treatment of HIV?
A: At first, we were really worried because some of our early HIV drugs, such as AZT, caused a bit of bone marrow suppression and that was a problem for some of the chemotherapy drugs. But, nowadays, the HIV treatments that we have really don’t interfere directly with chemotherapy, so people with HIV can continue their HIV treatment and can be treated for their cancer as well.
Q: What preventive measures can health care providers take to help reduce the risk for cancer in their patients with HIV?
A: Health care providers can do a lot better in terms of reducing the risk of smoking. For some reason, cigarette smoking is more common in some of the same groups that have a greater risk for HIV. We definitely see smoking related cancers like lung cancer. The one main thing that physicians can do is really be more effective in smoking cessation.
Short of that, I think the idea is really getting patients on an antiretroviral therapy to make sure their virus stays suppressed. Physicians should also be consistent in monitoring for cancers that may be more common, especially as patients get older.
Q: Research has shown that patients with HIV and cancer are less likely to receive oncology treatment. What can be done to increase cancer treatment among patients with long-term HIV infection?
A: There’s still a stigma associated with HIV infection. Many physicians are poorly informed, including some oncologists, and they don’t appreciate that HIV is relatively easily treated these days. The drugs are much less of a problem regarding interaction with cancer therapy. It’s a question of more effective education.
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