Guidelines Describe Appropriate Care for People Living With HIV and Cancer

New NCCN guidelines seek to reduce unnecessary, deadly cancer care gaps

The National Comprehensive Cancer Network (NCCN) has released new NCCN Clinical Practice Guidelines in Oncology intended to help make sure people living with human immunodeficiency virus (HIV) infection who are diagnosed with cancer receive safe, necessary treatment.

In 2010, an estimated 7,760 people living with HIV (PLWH) in the United States were diagnosed with cancer, representing an approximately 50% higher rate than the general population. However, studies have found PLWH are treated for cancer at significantly lower rates than HIV-negative people with cancer, despite most treatment courses being safe and effective in this population.

“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 to uninfected people,” said Gita Suneja, MD, of the Duke Cancer Institute. Dr. Suneja is Co-Chair of the NCCN Guidelines Panel for Cancer in People Living With HIV. “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 in people living with HIV are, in order of incidence: non-Hodgkin’s lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin’s lymphoma, oral/pharyngeal cancer, female breast cancer, and cervical cancer. The new NCCN Guidelines for Cancer in People Living With HIV include general advice—while highlighting the importance of working in collaboration with an HIV specialist—as well as specific treatment recommendations for non–small-cell lung cancer (NSCLC), anal cancer, Hodgkin’s lymphoma, and cervical cancer.

Additional recommendations can be found in the recently released NCCN Guidelines for AIDS-Related Kaposi Sarcoma, as well as the AIDS-related B-cell lymphomas section of the NCCN Guidelines for B-cell Lymphomas.

“The ultimate goal is to improve cancer survival among people living with HIV,” said Dr. Suneja. “With modern antiretroviral therapy (ART), 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.”

Among the recommendations found in the new NCCN Guidelines:

  • Most PLWH who develop cancer should be offered the same cancer therapies as HIV-negative individuals, and modifications to cancer treatment should not be made solely on the basis of HIV status.
  • Care for patients diagnosed with HIV should be co-managed with an oncologist and an HIV specialist (visit to find local specialists in the United States).
  • Oncologists and HIV clinicians, along with HIV and oncology pharmacists, if available, should review proposed cancer therapy and ART for possible drug–drug interactions and overlapping toxicity concerns prior to initiation of therapy.

“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 ART,” said Erin Reid, MD, of the University of California–San Diego Moores Cancer Center. Dr. Reid is Co-Chair of the NCCN Guidelines Panel for Cancer in People Living With HIV and Vice-Chair of the AIDS Malignancy Consortium Lymphoma Working Group. “Some antiretroviral-cancer therapeutic combinations have serious risk of increased toxicity, while 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.”

Dr. Reid also notes: “Another major area of concern oncology providers have in managing cancers in people living with HIV involves risk of infectious complications. The guidelines address infection prophylaxis considerations, including specific recommendations for PLWH receiving cancer therapy for whom profound immunosuppression/myelosuppression is anticipated.”

The NCCN Guidelines for Cancer in People Living With HIV are available free of charge for noncommercial use online at They can also be viewed via the Virtual Library of NCCN Guidelines mobile app for smartphones and tablets.

Source: NCCN; February 27, 2018.