Integrated Clinical Models of Care in People with HIV

The occurrence of some malignancies (ano-genital cancer and Hodgkin Lymphoma) in people with HIV (PWHIV) are increasing and cancers comprise of one third of Non-AIDS events in PWHIV. Approximately, 18% of cancer cases are caused by infection and 12% are caused by one of seven human tumour viruses (Hepatitis B and C, HTLV, Merkel Cell Polyomavirus, HPV, EBV, Kaposi Sarcoma Herpesvirus). Overall, HIV positive people with cancer have worse survival.

The speaker gave a comprehensive review on contributors to risk (age and CD4 count), prevention (immediate ART, HBV & HPV vaccinations, smoking cessation and metabolic risk factors) and opportunistic infection prevention, screening approaches (standard population screening and specific screening approaches) and treatment strategies for HIV infection and cancers.

It came as a surprise to me to hear PWHIV are routinely excluded from trials of anti-cancer agents, despite the disproportionate burden of malignancy. I agree with the speaker that patients with CD4+ T-cell counts >350 cells/mL and patients with no history or remote history of AIDS-defining opportunistic infections should generally be eligible for clinical trials. Exclusion limited to uncontrolled opportunistic infections may be appropriate. We should consider drug – drug interactions and modifying ART agents or prophylactic antibiotics as indicated.

Reflecting on the symposium and how this presentation will affect my clinical practice, the speaker suggested “Integrated Clinical Models” which will truly help PWHIV suffering from malignancies to achieve better outcomes. I now have a better understanding of the importance of combining HIV care of patients and cancer care for PWHIV and cancers.

 

Author bio: Dr. Zohreh Aminzadeh is an experienced overseas trained infectious disease specialist who is currently working as a sexual health registrar in Lismore (NSW).