By Steve Blanchard - May 18, 2020
Cancer patients have seen advances in their care thanks to cellular immunotherapy, at type of treatment that uses a patient’s own re-engineered immune cells to seek out and kill cancer cells. But there is one subset of patients who have been excluded from this breakthrough treatment: HIV-positive individuals.
Because of an immunocompromised status, this group of patients is often declared as less than perfect candidates for immunotherapy. But Dr. Anna E. Coghill, assistant member of the Cancer Epidemiology Department at Moffitt Cancer Center hopes that will change in the near future.
"We now have good data saying that immunotherapy is just as safe for HIV-positive patients as it is for others."- Dr. Anna E. Coghill, assistant member of the Cancer Epidemiology Department at Moffitt Cancer Center
“We now have good data saying that immunotherapy is just as safe for HIV-positive patients as it is for others,” said Coghill. “Publications such as the Journal of the American Medical Association have shared articles showing that as far as side effects and tolerances go, it’s comparable.”
Ongoing trials are still needed, Coghill added, but she believes that an HIV-positive patient who adheres to their treatment plan and is healthy could be a good candidate for immunotherapies to treat cancer. As a new member of the AIDS Malignancy Consortium, patients at Moffitt are finally gaining access to immune-based therapies trials specifically targeting this underserved patient population.
There are other factors to consider, however. “There are quite a few tumors that HIV-positive patients get more often than the general population,” Coghill said. “Most of these tumors are virus related, such as HPV-related anal cancer. This population is also more susceptible to lymphomas caused by Epstein-Barr virus and sarcomas that are caused by herpes viruses.”
There are also health behaviors in this community of patients that can lead to more cancer diagnoses. High smoking rates, for example, are reported in the HIV-positive community, causing a large percentage of HIV patients to develop lung cancer. This, combined with the increasing average age of the HIV population in the United States, are both contributing factors to lung cancer emerging as one of the two most common cancers to be diagnosed in HIV patients in the coming decade.
With the ongoing COVID-19 pandemic, HIV-positive patients need to be even more cautious in order to remain healthy. While there is a scarcity of data related to COVID-19 and HIV patients currently, Coghill urges patients to err on the side of caution.
“What we do know about their normal cancer risk is that this population needs to continuously be careful,” Coghill said. “There are guidelines from the Centers for Disease Control that HIV patients should adhere to, just as anyone else.”
Coghill particularly cautions older patients who are living with HIV. In 2019, she was part of a team that looked at whether cancer treatments had an impact on outcomes in this population.
The study used data from the Medicare database (patients 65 years or older) to demonstrate that elderly HIV-positive patients had a higher mortality rate after cancer diagnosis than their HIV-negative counterparts, particularly for common tumors such as breast and prostate cancer.
“As the HIV population continues to age, the association of HIV infection with poor breast and prostate cancer outcomes will become more important, especially because prostate cancer is projected to become the most common malignancy in the HIV population,” said Coghill. “It is why we are stressing the need for more research on clinical strategies to improve outcomes for HIV-infected cancer patients.”