Cancer is a devastating disease that impacts millions of people in the world. In addition to the physical and emotional toll it takes on individuals, cancer also affects their families and friends.

Cancer treatments can be especially difficult for those living with the human immunodeficiency virus (HIV) or AIDS since these conditions often lead to weakened immune systems. In fact, an HIV patient has a higher likelihood of developing cancer and is also more likely to die from the disease.

This blog post will discuss how cancer is treated in HIV-positive people and what they can expect if they are diagnosed.

Before cART

Before the advent of combination antiretroviral therapy (cART), the prognosis for people living with HIV or AIDS who got cancer was very poor.

This was because HIV weakened the immune system, which led to their cancer spreading rapidly, and before effective treatment could be administered, it would often result in death.

In addition, cancer treatments such as chemotherapy or radiation weaken the immune system, making patients more susceptible to opportunistic infections. In an already-sick HIV infected patient, this made for a very unfavorable outcome.

Many healthcare professionals opt for administering a lower dosage of chemotherapy to tolerate the drug better and reduce its toxicity. Unfortunately, this approach rarely resulted in long-term remission.

However, all of that has changed with the introduction of cART.

The cART Revolution

Since the introduction of cART, the prognosis for HIV-positive patients and HIV-positive cancer patients has improved dramatically. Many people with HIV or AIDS can now be treated effectively for their cancer.

This is due to a couple of factors:

• The ability of cART to suppress the virus and partially restore immune function.

• The development of new cancer treatments is more effective and less toxic than older ones.

It is vitally important that HIV-positive cancer patients receive highly active ART during and after cancer treatment. This will help suppress the virus, improve immune function, and reduce the risk of developing cancer recurrences.

Patients should also be vigilant about taking their HIV medicine as prescribed and seek medical attention if they experience any side effects.

Cancer Treatment Types

What type of treatment a person with HIV or AIDS will receive for their cancer depends on a multitude of factors, similarly to HIV-negative cancer patients:

• Type of cancer
• Stage of cancer
• Location of cancer
• Immune system function – as evidenced by the viral load or CD4 count
• Age and overall health of the patient
• Possible cancer treatment side effects, and more

There are a variety of treatments available for people with HIV or AIDS and cancer, including chemotherapy, radiation therapy, surgery, and targeted therapies. Thanks to cART, the dosage of chemotherapy can be safely increased to achieve long-term remission.

Each person’s situation is unique and will require a personalized treatment plan. During cancer treatment, doctors will carefully monitor the immune system’s strength and make adjustments to the treatment plan as needed.

AIDS-defining cancers – such as Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer – have certain treatment protocols specific to the condition. In contrast, other cancers might require a more generalized treatment plan.

Kaposi Sarcoma Treatment

If the patients diagnosed with KS are not taking antiretroviral therapy, they are recommended to start cART. For some, regularly taking cART can be enough to put KS into complete remission. However, for others, it is also necessary to apply other types of therapy after the first signs of cancer are detected.

A few most common methods can be used for treating KS in an HIV-positive patient, depending on the severity and location of the lesions.

• Mild form of lesions

If the lesions are localized and only on the skin’s surface or mucosa, such as around the mouth, they can be treated with surgery or radiation therapy.

Two types of surgery are commonly used to remove KS lesions:

Curettage and electrodesiccation – the removal of the lesion by scraping it off with a curette, then applying an electrical current to stop any bleeding. It may leave a pale, flat scar.

Cryosurgery – applying extreme cold (liquid nitrogen) to the lesion, which causes it to die and fall off. It may also leave a pale scar.

• Severe lesions

If the lesions are more widespread or are internal, chemotherapy may be recommended. Chemotherapy drugs may be applied via an intralesional injection (injection directly into the lesion), orally, or intravenously.

Alternatively, a special treatment method specifically for this type of lesion is called photodynamic therapy. It involves using a photosensitizing agent (light-sensitive substance), which is injected into the lesion. The agent accumulates in cancer cells and is activated by light therapy (such as a laser). This destroys the cancer cells.

Non-Hodgkin Lymphoma Treatment

The types of non-Hodgkin lymphoma linked with HIV/AIDS are usually aggressive and difficult to treat.

The most common treatment for NHL is chemotherapy, which may be given as a pill or intravenously. Radiation therapy is also used in some cases.

Recently, significant progress has been made in developing new treatments for non-Hodgkin lymphoma, including targeted therapies that specifically attack the aggressive cancer cells.

Immunotherapy is also an option, especially drugs such as rituximab – a monoclonal antibody designed to attack lymphoma cells. The FDA has approved it for treating follicular non-Hodgkin lymphoma, diffuse large B-cell lymphoma, and chronic lymphocytic leukemia. Other monoclonal antibodies used for non-Hodgkin lymphoma are obinutuzumab, ofatumumab, and rituximab-adds.

Cervical Cancer Treatment

HIV-positive women with invasive cervical cancer and good immune function are mostly treated the same way as HIV-negative women.

The most common treatments for cervical cancer are surgery, radiation therapy, and chemotherapy. For early-stage cancers, surgery may be the only treatment needed. More advanced cases typically require a combination of therapies.

HIV-positive women are more likely to experience side effects from treatment, so that they may need additional support and care.

Before the development of full-blown cervical cancer, most HIV-positive women are first diagnosed with a precancerous condition called cervical intraepithelial neoplasia (CIN). Because of the weakened immune system, standard treatments for CIN are usually not as effective in HIV-positive women. In these cases, regular HIV treatment can help lessen the progression of the disease.

Drug Interaction

One of the biggest concerns in combined HIV and cancer treatment is drug interactions between the different medications used.

This is why a whole team of specialists is typically involved in the care of a person with HIV and cancer – to help prevent any harmful interactions from happening.

It’s important to always tell all of your doctors about all of the medications you are taking, including over-the-counter drugs and supplements. This includes prescription drugs and herbal remedies, and other natural products. In complex cases such as treating HIV-positive cancer patients, it could mean the difference between life and death.

Conclusion

In the past, people with HIV or AIDS had extremely limited treatment options for cancer.

But today, with new and innovative treatments being developed all the time, there is hope for people living with both HIV and cancer. An HIV-positive cancer patient usually receives the same treatment as an HIV-negative cancer patient, but with some modifications to consider their weakened immune system. And while there are still some challenges to face, the outlook for people living with both HIV and cancer is getting better.

While each case is unique, a multidisciplinary team approach will most likely be necessary to provide the best possible cancer care. With advances in research and technology, we can expect much more progress in cancer treatment for people living with HIV.

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