Guidelines for Cancer Treatment in PLWH

• All cancer patients with HIV should begin or continue highly active anti-retroviral therapy (HAART) while undergoing treatment for cancer

• Changes to HAART may be required to prevent drug-to-drug interactions. This decision should be made with an HIV pharmacist and oncology pharmacist

• HAART should not be interrupted if possible. Continuation of HAART may actually increase tolerance to cancer treatments and improve response rates and outcomes

• Cancer treatment should not be delayed for HIV treatment if possible

• Increased monitoring of CD4+ count and viral load may be indicated if a patient's cancer treatment is know to interfere with HAART or cause a drop in infection-fighting white blood cells

• Appropriate prophylaxis should be given depending on a patient's HIV status and cancer

• HIV status alone should not be a determining factor in the decision to pursue surgical therapy

• Overall health is more predictive of surgical outcomes than CD4+ count

• HIV status alone should not be a determining factor in the decision to pursue radiation therapy

• Radiation therapy can be administered for curative or palliative care

• PLWH are 3-5 times more likely to develop cervical cancer than the general population

• Premalignant cervical lesions can be safely treated and removed. However, PLWH are more likely to have endocervical extension of these lesions which makes removal by loop excision difficult

• PLWH who develop cervical cancer should be treated per standard guidelines. No modifications to cancer treatment are recommended on the basis of HIV status alone

• PLWH who develop cervical cancer should start or continue HAART and be co-managed by an HIV specialist and oncologist

• Cervical cancer is caused by high-risk human papilloma virus (HPV). PLWH with cervical intraepithelial neoplasia or invasive cervical cancer should also be evaluated for anal cancer, which can also be caused by HPV

• PLWH are 25-35 times more likely to develop anal cancer than the general population

• PLWH who develop anal cancer should be treated per standard treatment guidelines. No modifications to treatment should be made on the basis of HIV infection alone

• Surgical excision for early-stage T1 perianal cancer and chemoradiotherapy are effective in PLWH

• For persistent or recurrent disease, abdominoperineal resection (APR) may be required. HIV status is not associated with worse post-surgical outcomes after APR

• PLWH who develop anal cancer should start or continue HAART and be co-managed by an HIV specialist and oncologist

• Anal cancer is PLWH is often associated with human papilloma virus (HPV). PLWH should be evaluated for vulvar, vaginal, and cervical cancer which can be caused by HPV

• PLWH are 2-5 times more likely to develop non-small cell lung cancer (NSCLC) than the general population

• PLWH who develop NSCLC should be treated per standard treatment guidelines

• PLWH who develop NSCl cancer should start or continue HAART and be co-managed by an HIV specialist and oncologist

• PLWH are 5-14 times more likely to develop Hodgkin lymphoma (HL) than the general population

• In PLWH, 90% of HL cases are Epstein-Barr virus (EBV) associated

• Of the standard HL treatment regimens, ABVD appears less toxic than Standford V or BEACOPP in PLWH, and may be the preferred treatment

• Growth factor supplementation with ABVD treatment may be required, especially for patients with low CD4+ counts, neutropenia, or neutropenic fever

• Dose reduction of ABVD may be required in PLWH with severe cytopenias

• PLWH who develop HL and have a CD4+ T cell count less than 200 cells/ul may require prophylactic antibiotics to protect against Pneumocystis pneumonia and certain other infections

• PLWH who develop HL should start or continue HAART and be co-managed by an HIV specialist and oncologist

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Cancer in People with HIV, Version 1.2022. Accessed 02/05/2022

Cancer Therapy Evaluation Program. (n.d.). Guidelines regarding the inclusion of cancer survivors and HIV-positive individuals on clinical trials. Retrieved April 12, 2022, from https://ctep.cancer.gov/protocoldevelopment/policies_hiv.htm