New Data on Cancer Rates Among HIV-Positive People ‘Underline’ Need for Antiretrovirals That Restore Immune Function, Opinion Piece Says
New data on cancer rates among HIV-positive people "underline" the need for the development of antiretroviral drugs that "restore immune function more effectively" than currently available treatments, Mark Wainberg -- director of McGill University's AIDS Centre at the Jewish General Hospital in Montreal, Canada, and former president of the International AIDS Society -- writes in a Washington Post opinion piece.
As a result of increased life expectancy because of new antiretrovirals, clinicians and researchers are seeing higher rates of several "life-threatening" cancers among people who have been HIV-positive for long periods of time, Wainberg writes. These cancers include lymphomas, carcinomas and lung cancers, according to Wainberg, who adds that although the "numbers are still relatively small overall, these cancers are occurring with far higher frequency among" HIV-positive people than among the general population. One reason for the increase is that HIV causes a decline in immunological function that "cannot be completely repaired" by antiretrovirals, according to Wainberg. Treatment helps ensure that HIV-positive people will not acquire some infections, but the immune system still might be compromised in its ability to protect against cancer, he notes.
According to Wainberg, the increases in cancer incidence "raise a number of important concerns" -- including whether rates of cancer among HIV-positive people will continue to increase and whether the cancers will be "restricted to certain types or will diversify." Another concern is related to treatment because chemotherapy temporarily might prevent the use of antiretrovirals, Wainberg writes, adding that such interruptions in treatment could "lead to renewed replication of the virus and exacerbation" of progression to AIDS. In addition, "long-term surveillance" is needed to track whether people living with HIV for 10 to 25 years will become more susceptible to developing cancer as antiretroviral therapy improves, Wainberg writes.
According to Wainberg, although the number of cancers seen among HIV-positive people could "plateau," widespread "damage" to the immune system already might have occurred in almost all patients, regardless of when they were diagnosed, by the time they start antiretroviral therapy. The "changes" the data on cancer "reflect in the evolution of HIV/AIDS as a long-term condition and in the quality of life of those living with it are vivid reminders that AIDS remains a fearsome disease, despite all the progress we've achieved over a quarter-century in therapies, acceptance and awareness," Wainberg concludes (Wainberg, Washington Post, 12/4).