Why Having HIV and Cancer Means You Are Less Likely to be Treated for Cancer

University of Pennsylvania researchers have found that HIV positive patients with cancer are between two and four times more likely to have their cancer go untreated compared to patients without HIV.

Researchers surveyed data for 3,045 people with HIV and cancer along with 1,087,648 people without HIV but with cancer between the years 1996 and 2010. They then compared treatment rates for several cancers, including lymphoma, cervical cancer, lung cancer, breast cancer and colorectal cancer, among others.

Lymphoma

In early-stage lymphoma (specifically, the research team looked at both diffuse large B-cell lymphoma and Hodgkin's lymphoma), the percentage of patients who did not receive standard treatment were:

• HIV positive: 43.7
• HIV negative: 35.8

Cervical Cancer

In cervical cancer (no staging indicated), the percentage of patients who did not receive standard treatment were:

• HIV positive: 6.4
• HIV negative: 4.7

Lung Cancer

In early-stage lung cancer, the percentage of patients who did not receive standard treatment were:

• HIV positive: 33.3
• HIV negative: 18.5

Colon Cancer

In early-stage colon cancer, the percentage of patients who did not receive standard treatment were:

• HIV positive: 20.8
• HIV negative: 4.6

Breast Cancer

In early-stage breast cancer, the percentage of patients who did not receive standard treatment were:

• HIV positive: 11.1
• HIV negative: 4.8

The Question Why

"The results of this study are very concerning," said Dr. Gita Suneja, an adjunct assistant professor at Penn's Perelman School of Medicine, and the study's lead author. "[They] require further investigation to understand why such a substantial proportion of HIV-infected cancer patients are not undergoing life-saving treatment."

One possible explanation is the absence of any established data regarding HIV positive patients and cancer treatment efficacy. In other words, people with HIV are generally if not always excluded from clinical trials for cancer treatment, if for no other reason, the pharmaceutical company funding the trial doesn't want HIV patients included for fear that their health might put them at risk of adverse events and therefore negatively skew their results.

If that sounds pessimistic or cynical, you have no idea of the lengths that such companies will go to to assure positive clinical trial data.

Additionally, there simply aren't a lot of trials out there that only include HIV positive patients receiving treatment for cancer. A fair assessment of the state of medicine suggests to me that this should change soon, since antiretroviral treatments have turned HIV from a death sentence in waiting to a manageable virus; thus, people with HIV are living longer and are therefore at greater risk of developing cancer—cancer that is unrelated to their HIV status.

"Oncologists rely on guidelines based on such trials for treatment decision making," added Dr. Suneja. "In the absence of guidance, they may elect not to treat HIV-infected cancer patients due to concerns about adverse side effects of poor survival."

This conclusion feels a bit undermined by some of the factors the team found to be independently associated with being HIV positive and having cancer but not receiving cancer treatment: low CD4 count; being a man and having been infected with HIV from IV drug abuse; being between 45 and 64; being black; and having either advanced-stage cancer or unknown-stage cancer.

Source: JCO: Cancer Treatment Disparities in HIV-Infected Individuals in the United States