Are HIV Patients Undertreated for Cancer?

By Sara Bondell - April 14, 2023

Unlike in the 1980s, a diagnosis of HIV or AIDS is no longer a death sentence. Thanks to the introduction of antiretroviral medications, a majority of patients can live normal lives. However, with increased longevity, they now face the growing burden of being diagnosed with other diseases, such as cancer. Cancer is the second leading cause of death among people with human immunodeficiency virus in the United States.

Florida has one of the highest HIV transmission rates in the country, trailing only Washington, D.C., and Georgia. In 2020, there were 114,541 people living with HIV in Florida. That same year, 3,408 people were newly diagnosed with the virus.

Patients with HIV are less likely to receive any cancer treatment, however, reasons for the disparity are unknown. One potential provider-level reason for these observed inequities is that treating oncologists may have concerns about potential drug-drug interactions between cancer and HIV treatments.  To inform this concern, a team of researchers at Moffitt Cancer Center investigated the burden and sociodemographic determinants of potential drug-drug interactions between highly active antiretroviral therapy and systemic therapy among cancer patients with HIV.

Dr. Jessica Islam, cancer epidemiologist
Dr. Jessica Islam, Cancer Epidemiology

“One of the reasons that comes up pretty often is limited clarity regarding cancer treatment recommendations for people who are HIV positive largely because of the potential for interactions between antiretroviral therapy and systemic therapy, such as chemotherapy. Oncologists have reported in prior work that they are not well versed in these potential interactions and that is one of many reasons they may forgo providing treatment,” said Dr. Jessica Islam, a cancer epidemiologist who led the study.

The study used the SEER-Medicare database to identify 667 individuals over the age of 64 diagnosed with breast, prostate, colorectal and non-small cell lung cancer who were also filling prescriptions for antiretroviral medication. Researchers then used the database to determine which patients received cancer treatment.

The findings, which were presented at the American Association for Cancer Research annual meeting, show that 1 in 4 eligible individuals receiving systemic therapy were exposed to a potential drug-drug interaction. Researchers also found that non-Hispanic Black adults, women and those with later-stage cancer were more likely to experience a drug-drug interaction.

“I think the take home message is that these are potential groups living with HIV that we could focus future tailored efforts on to improve quality of care that are delivered to these groups, particularly non-Hispanic Black adults,” Islam said.

Since this study only identified patients who could experience potential drug-drug interactions, future studies would need to investigate if drug-drug interactions actually cause adverse outcomes.

In 2017, the National Comprehensive Cancer Network changed its guidelines for treating those who are HIV positive and diagnosed with cancer. The new guidelines focus on treating a person with HIV whose disease is controlled the same way as the general population.

“At Moffitt, it’s important for us to be thinking about cancer care equality, especially since the state of Florida has one of the highest burdens of HIV in the U.S.,” Islam said. “We have to be mindful of patients we see with HIV, what kind of comorbidities they have and ensuring that everyone is getting the highest care possible regardless of any preexisting conditions.”

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