Módulo 2 – Curso pós-graduado – VIH e Envelhecimento

Non-AIDS Defining Cancers Among HIV Infected People

Clinical Management of non-AIDS defining cancers

Autor: Prof. Doutor Vicente Estrada, MD PhD (Hospital Clínico San Carlos, Madrid, Spain)

HIV infection and NADCs

Despite the widespread use of ART, HIV-infected patients might develop certain types of cancer more frequently than uninfected people1. Incidence of NADCs is increased in HIV-infected individuals, in particular in older patients, who account for the majority of malignancies of HIV-infected patients.

Data shows that risk of NADC seems to be independently increased with older age, smoking status, longer cumulative exposure to combination ART, and active HBV and HCV infection1. Decreased immune surveillance or increased inflammation and immune activation associated with HIV infection may also contribute to risk.

The effects of ART remain controversial. Some studies have identified that longer cumulative exposure to combination ART seem to be a risk factor for NADCs. However, the INSIGHT START trial shows that the immediate initiation of ART in patients with high CD4+ cell counts, results in additional health benefits, including the risk of developing the cancers not related to AIDS.

Management of HIV-infected patients with cancer requires a multidisciplinary approach, involving both oncologists and HIV physicians to provide optimal follow-up of both diseases and drug interactions between anti-cancer and antiretroviral drugs.

Lung cancer, HL, anogenital HPV-related neoplasias, and hepatocellular carcinoma are among the most frequent NADCs in HIV patients.

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