In people with HIV and cancer, antiretroviral therapy is often used during cancer treatment to mitigate complications of HIV progression. However, questions regarding long-term effects of cancer treatment in this patient population remain, such as the immunosuppressive effects on HIV RNA level and CD4 count, which are indicators of a patient's morbidity and mortality. Therefore, scientists sought to measure the link between these biomarkers and associated mortality after cancer treatment. They predicted that in patients with HIV treated with chemotherapy and/or radiotherapy, HIV RNA levels would increase, thereby reducing treatment tolerability. In addition, investigators believed CD4 count would decrease initially, but levels would eventually recover. The study showed that patients with HIV and cancer who receive chemotherapy and/or radiotherapy experienced a decrease in CD4 count after treatment, increasing their risk of mortality.
For this study, published in JAMA Oncology, 196 participants with HIV and cancer were enrolled in the Johns Hopkins HIV Clinical Cohort. Over half the study population were male with a median age of 50 years. The investigators collected data based on the type of initial treatment each patient received, using the following categories: chemotherapy, radiotherapy, surgery, hormone therapy, immunotherapy, and other.
Results revealed that among those with an initial baseline CD4 count of greater than 500 cells/µL, receiving chemotherapy and/or radiotherapy caused that count to drop by 203 cells/μL, and for those with a baseline CD4 count of less than 350 cells/ μL, CD4 count level declined by 45 cells/μL. For every drop in CD4 count by 100 cells/ μL, mortality increased by 27%. No harmful association was detected between chemotherapy and/or radiotherapy and HIV RNA levels.
Rachel Bender Ignacio, MD, MPH, of University of Washington School of Medicine, and colleagues provide commentary on this study, "The study by [Dr. Calkins and colleagues] highlights the need to limit immunosuppressive therapies. Improved methods to evaluate immune function in people with HIV and cancer are also needed."
For More Information
Calkins KL, Chander G, Joshu CE, et al (2019). Immune status and associated mortality after cancer treatment among individuals with HIV in the antiretroviral therapy era. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2019.4648
Image Courtesy of Bette Korbor of Los Alamos National Laboratory