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Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 85-92

Review: The impact of HIV infection on cancer treatment with immunotherapy

Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Correspondence Address:
Dr. Bruno Palma Granwehr
Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JIPO.JIPO_14_19

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Human immunodeficiency virus (HIV) and cancer have been intimately linked since the first cases of HIV were identified after investigation of unusually high rates of Kaposi's sarcoma in patients without other risk factors. HIV not only impairs the immune system but also drives a chronic inflammatory response. The significance of the chronic inflammatory response has become more evident, as patients with HIV survive longer on antiretroviral therapy, developing cancers more typical of the aging population. Cancer treatment offered to patients with HIV includes traditional cytotoxic chemotherapy, surgery, and radiation. Some oncologists abbreviate courses or reduce doses of treatment in patients with HIV. The promising field of immunotherapy, exemplified by immune checkpoint inhibitors (ICIs), has revolutionized cancer care. Some of the first studies of ICIs conceived of these agents as an approach to overcome “immune exhaustion” in patients with HIV and other chronic viral infections. In fact, clinical trials are underway to assess the impact of ICIs on patients with HIV with low CD4 counts, despite virologic suppression. Experience with ICI in patients with HIV and cancer is limited, but available studies suggest that HIV remains well-controlled, with CD4 count stable to increasing and viral load stable to decreasing. Immune-related adverse effects have varied, with one case series reporting higher than expected rates, but immune reconstitution inflammatory syndrome has not been reported. In addition to these other therapies, stem cell transplant (SCT) has been demonstrated to be safe and effective. In selected patients with HIV, SCT has even led to the cure of HIV, as noted in two confirmed cases. The treatment of patients with HIV and cancer will benefit from clinical trials designed for this population, as well as new guidelines to aid oncologists in providing care for these patients. Collaboration between oncologists and HIV providers is essential in managing the treatment of HIV during cancer therapy, as well as addressing infectious and other complications that arise. This collaboration will lead to continued improvement in the management of this growing patient population.

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