HIV-positive cancer patients have a worse outcome with prostate cancer and breast cancer. Carcinomas progress more rapidly and cancer-related mortality also increases.
Thanks to the increasing progress in therapy approach, patients with HIV nowadays almost achieve a life expectancy that corresponds to that of the total population. For this reason, there will also be more elderly people with HIV in the future.
Older people, on the other hand, suffer more frequently from malignant diseases, so that the group of older people with HIV infection could represent a relevant patient group in the future. Despite antiretroviral therapy, HIV-infected people have a higher risk of cancer.
A US study (see source below) used data from more than 308,000 cancer patients with advanced disease and an average age of > 65 years. Of these study participants, 288 were HIV positive.
In HIV-infected cancer patients, overall mortality increased significantly compared to non-infected tumor patients. The mortality rate was also increased by 17% to 73%, depending on the type of tumor. The researchers also found such differences for cancer-related mortality: prostate cancer (HR = 1.65) and breast cancer (HR = 1.85).
An interesting aspect is that possible deviations of the cancer therapies from the current standard were not the cause of the observed differences. Since there will be a larger number of people with a combination of tumor diseases and HIV infection in the future, the treatment strategies should nevertheless be urgently optimized.
It is also possible that the acquired immunodeficiency will lead to a worsening of tumor response and therefore to increased tumor growth. This means that, despite cancer therapy, only limited control of tumor cells is possible, particularly in prostate and breast cancer. All in all, the combination of HIV and tumor diseases will become more and more important in medical practice, and in particular in geriatrics in the coming years, in line with the demographic change in our society.
Coghill AE et al., HIV Infection, Cancer Treatment Regimens, and Cancer Outcomes Among Elderly Adults in the United States. JAMA Oncol 2019; doi:10.1001/jamaoncol.2019.1742