Study Finds Cancer Treatment Gap for HIV-Infected Patients

Gita Suneja, MD

People infected with HIV who have also developed cancer are two to four times more likely to not receive treatment for their cancer compared to uninfected cancer patients, according to a study from Penn Medicine’s Abramson Cancer Center and the National Cancer Institute (NCI).

Life expectancy for HIV-infected people is now similar to uninfected people, but survival for HIV patients who develop cancer is not. Although many studies have attempted to understand why HIV-infected cancer patients have worse outcomes, the new study, the largest of its size and scope, examined differences in cancer treatment as one potential explanation.

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. For early-stage cancers that have the highest chance of cure with appropriate treatment, those with HIV were two to four times as likely to not receive appropriate cancer treatment, the researchers found.

“In my clinical experience, I have seen uncertainty surrounding treatment of HIV-infected cancer patients,” 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 said in a statement.

“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.”

While most current HIV treatments are safe, tolerable, and effective, treatments for cancer patients with HIV can be clinically challenging due to drug interactions and the potential increase in immunosuppression from chemotherapy or radiation.

For the study, researchers used data from NCI’s HIV/AIDS Cancer Match Study to study adults diagnosed with non-Hodgkin lymphoma, Hodgkin lymphoma, or cervical, lung, anal, prostate, colorectal, or breast cancer from 1996 through 2010.

Over 3000 HIV-infected and one million uninfected cancer cases were examined for the study, the researchers said.

The researchers suggest that in order to help close the disparity gap among HIV-positive patients with cancer and those not infected, cancer clinical trials should begin enrolling HIV-infected patients, 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 Suneja. “As cancer becomes an increasingly common cause of death in the HIV population, the issue of cancer treatment in the HIV-infected cancer population will grow in importance.”

The study was published online ahead of print June 30, 2014 in the Journal of Clinical Oncology.