While medications are helping HIV-positive people avoid developing full-blown AIDS indefinitely, a new study, published online on June 30 in the Journal of Clinical Oncology, finds that cancer patients with HIV are up to four times less likely to be treated for their tumors.
The research comes with caveats. It looked at just three states from 1996, when powerful HIV drugs first began changing the face of the disease, to 2010, when patients routinely took the medications, and the study doesn't explain why HIV-positive people with cancer receive less treatment or how this affected their lifespans.
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Still, "the main message is that these patients are not receiving appropriate cancer therapy," said study author Dr. Gita Suneja, assistant professor of radiation oncology with the University of Utah. "There's a lack of awareness about the issue as a whole because any one physician will see few of these patients. It's something that we need to focus on."
In the 1980s and early 1990s, patients with AIDS - the disease caused by infection with HIV - often didn't live long enough to develop cancer, other than a few types linked to the failure of their immune systems. Now, HIV patients often don't develop AIDS and are likely to become ill with cancer as they age.
However, these patients aren't the same as others with cancer. HIV-infected people are more likely to develop lung, anal and immune system cancers, possibly because the tumors begin developing before they begin taking HIV medication, said Dr. Michael Horberg, director of HIV/AIDS with Kaiser Permanente.
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The new study compared patients in the United States with cancer: more than 3,000 with HIV, and more than 1 million without HIV. The researchers found that the HIV patients were less likely to have received standard treatment for certain types of colon, lymphoma and lung cancers. HIV patients were also more likely to have not received any treatment for certain types of lymphoma, lung, prostate and colorectal cancers.
Among those with a type of lung cancer, for instance, one-third of the HIV patients didn't get the standard surgical treatment, compared to 19 percent of the other patients.
What's going on? Patients may be offered treatment but decline it, said Suneja, who worked on the study while at the University of Pennsylvania. Treatment challenges, which can include drug interactions and a potential increase in immunosuppression after chemotherapy or radiation, may also play a part in the differences, the researchers said.
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Horberg said it's also possible that the cancers weren't caught early or that cancer physicians didn't treat the patients as aggressively as they could have.
He also said physicians need to be more careful about making sure that HIV patients don't have cancer, even if the patients are young. "Screening for cancer has to be a key element of HIV care," Horberg said. "There has to be increased vigilance. A physician may not be thinking of lung cancer or anal cancer when a patient is at a younger age, but you actually have to think about it earlier than usual."
In the bigger picture, HIV patients with cancer "should have access to the cutting-edge therapies and be enrolled in studies so we can gather information about how effective these treatments are for them," he said.
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