Cancers Increasing in HIV-Infected Patients

Little known about combining antiretroviral and anticancer drugs

THURSDAY, July 10 (HealthDay News) -- Although treatment advances have reduced HIV-related deaths in HIV-infected patients, they are at increasing risk of dying from cancer, and little is known about optimal treatments or the effects of combining antiretroviral and anticancer drugs, according to a review published online June 30 in the Journal of Clinical Oncology.

Jean-Philippe Spano, M.D., from Assistance Publique Hopitaux de Paris in France, and colleagues note that cancer remains an important cause of death in HIV-infected patients in spite of the reduction in HIV-related mortality due to combination antiretroviral therapy. Although treatment has reduced the incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma, patients are still susceptible to non-AIDS-defining malignancies, which tend to be more aggressive and more advanced at diagnosis.

An additional problem with treating these malignancies is the fact that antiretroviral medications can inhibit or induce the cytochrome P450 enzyme system, which may cause drug interactions, according to the authors. Since anticancer drugs are also metabolized by cytochrome P450, this can result in either drug accumulation or non-efficacious drug levels. They suggest that combined safety and pharmacokinetic studies need to be done for antiretroviral and anticancer drugs.

"In conclusion, the emerging reports of malignancies, especially of non-AIDS-defining malignancies, represent a new challenge in the care of patients with HIV infection," Spano and colleagues write. "Many efforts must be addressed, including optimal prevention strategies, frequency of screening, and monitoring of patients."

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