Epidemiological data
HIV infection remains a current problem. In 2022, 39 million people were living with HIV (PLHIV) worldwide, representing a median prevalence of 0.7% in the adult population. It is striking to note that 16% of PLHIV are not aware of their infection.
In 2021, Italy recorded just under 1,800 cases of HIV infection and 380 cases of AIDS. The data also shows an increase of approximately 9 percentage points (from 53.3% to 61.9%) between 2012 and 2021 in the proportion of people receiving a new late diagnosis of HIV infection with a rate of CD4 < 350.
Regarding cancers, the International Center for Research on Cancer (IARC) in Lyon identified HIV as a causative agent of cervical, anal and conjunctival cancers, Kaposi’s sarcoma, as well as Hodgkin’s and non-Hodgkin’s lymphomas. It also highlighted a positive association with vulvar, vaginal, penile, liver (hepatocellular carcinoma) and non-melanoma skin cancers. “The effect is not direct, but mediated by immunosuppression”explained Dr. Diego Serraino, director of the Complex Cancer Epidemiology Operational Unit at Aviano CRO.
In terms of classification, we distinguish between cancers classifying AIDS, such as Kaposi’s sarcoma, non-Hodgkin’s lymphoma and cervical cancer, and those not classifying AIDS, correlated (cancer of the anus or liver ) or not (lung cancer) to the virus.
“Since the 1990s, with the introduction of antiretroviral treatment (ARV), we have observed a reduction in cases of AIDS-classifying cancers, but also, conversely, an increase in other non-AIDS-classifying cancers”explained Dr. Davide Dalu, oncologist at the single infectious disease-oriented oncology unit at the Luigi Sacco Hospital in Milan. “Predictive models suggest that in 2030, the most common cancers among the PPHIV population will be those of the prostate, lung and liver”he added.
Cancer and HIV, a complex link
Cancer remains the leading cause of death among HIV-infected patients. The improvements observed in recent years, particularly since 2005 with the introduction of integrase inhibitors, are probably attributable to various factors such as earlier diagnosis, increased attention to the problems of PLHIV and an overall improvement in treatments against HIV. cancer.
But why do cancer patients with HIV have less favorable outcomes than those without infection? “ The reasons are multiple”said Dr. Dalu, citing the molecular basis by which HIV plays a role in tumorigenesis, the advanced stage of presentation of cancers in patients with HIV, and the fact that HIV infection is considered a exclusion criterion in approximately 80% of clinical trials.
Additionally, HIV-infected cancer patients also have a significant burden of cardiovascular, skeletal, and neurocognitive comorbidities, are often on polypharmacy, and tolerate treatment less well. Finally, with the exception of anal cancer, HIV-positive cancer patients are not cared for, receive insufficient care or are cared for inappropriately compared to the general population. “It’s a kind of cultural heritage from the past and everything we do today goes precisely in the direction of reducing this gap”emphasized Dr. Dalu.
Keywords: cooperation and equal access
The initiative NAMES Project AIDS Memorial Quiltthere “name coverage” dedicated to people who have died from AIDS, was launched in 1987. Since then, significant progress has been made and HIV patients are now benefiting from treatments that can be a real game-changer. Thanks to collaboration between various specialists, it also becomes possible to achieve previously unimaginable results, including cases of cure, observed in a handful of patients worldwide until now. This was highlighted by Dr. Cristina Mussini, director of the complex infectious diseases unit at Modena University Hospital, Italy, who has worked with HIV patients since the late 1980s, when infection was a major problem. a real death sentence.
“There is still a long way to go to ensure equitable access to medicines, which includes equitable access to clinical trials”added Daria Russo, representative of NPS Italia APS, the network of HIV-positive people, referring to the equation (Undetectable = Untransmittable). “This equation was a real cultural and social revolution: knowing that an HIV-positive person under ARV treatment for at least six months and having an undetectable (zero) viral load does not transmit the virus has given the HIV-positive population a new life and the possibility of making plans »she said.
It is now crucial, and theEuropean AIDS Treatment Group also calls for it to expand access to clinical trials based on the model of Food and Drug Administration (FDA), which has already included the HIV-positive population in non-HIV-specific trials. “This inclusion is beneficial both on a personal level for patients and on a medical level”concluded Daria Russo.
