People living with HIV who are diagnosed with cancer should be offered the same treatment as those without HIV; however, considerations should be made for potential interactions and toxicities, according to new practice guidelines from the National Comprehensive Cancer Network.

“The disparity in cancer care is large and significant. For most cancers, people living with HIV are two-to-three times more likely to receive no cancer treatment compared [with] uninfected people,” Gita Suneja, MD, associate professor of radiation oncology and global health at Duke Cancer Institute, said in a press release. “Although we don’t yet know all the reasons for these large differences in cancer treatment, the lack of clinical management guidelines available to clinicians has been shown to be one contributing factor.”

The most common types of cancer occurring among people with HIV include non-Hodgkin lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral/pharyngeal cancer, female breast cancer and cervical cancer

The NCCN guidelines offered the main takeaway that people with HIV who develop cancer should be offered the same treatment as people who are HIV negative.

“The ultimate goal is to improve cancer survival among people living with HIV,” Suneja said in the release. “With modern antiretroviral therapy, people with HIV are living longer and, therefore, getting more cancers related to both HIV infection and aging. The bottom line is that the cancer burden is growing — in fact, cancer is quickly becoming the leading cause of death in people living with HIV — so we urgently need to improve cancer treatment in this population.”

Treatment considerations

Cancer treatment modifications for people with HIV should not be made based solely on the basis of a patient’s HIV status, according to the recommendations.

The guideline authors further recommended that an HIV specialist be included in the cancer-care team for patients with HIV.

An HIV specialist along with oncology and HIV pharmacists should review proposed cancer therapy to look for possible drug-to-drug interactions or overlapping toxicities.

“One of the most important points we want providers to be aware of surrounds the potential for drug interactions and overlapping toxicities between cancer therapeutics and [antiretroviral therapy],” Erin Reid, MD, clinical professor at UC San Diego Moores Cancer Center, said in the release. “Some antiretroviral-cancer therapeutic combinations have serious risk for increased toxicity, whereas others may reduce levels of either cancer therapeutics or the antiretroviral. The good news is that with the expansion of antiretroviral combinations available, there is opportunity to minimize these risks by modifying antiretroviral therapy during cancer treatment.”