A retrospective study of clinical spectrum and treatment outcomes of HIV associated cancers in a tertiary care centre

Introduction: With the introduction and widespread availability of highly active anti-retroviral therapy (HAART), the landscape of HIV/AIDS has changed considerably. This is true for HIV-associated malignancies as well. Post-HAART, the incidence of Kaposi's sarcoma and central nervous system (CNS) lymphoma (among AIDS-defining cancers) decreased in parallel with AIDS-defining infections. On the other hand, the incidence of systemic non-Hodgkin's lymphoma (NHL) and cervical cancer decreased less than others and remains higher in HIV-infected patients than in the general population. Currently, malignancies are the most frequent underlying cause of death (around one-third) of HIV-infected patients. Materials and Methods:The study was a retrospective observational study which included all the patients with HIV and cancer attending the Oncology Department OPD, GovtMedical College, Jammu between January 2020 and December 2020.Data obtained from the case records was used to fill up the proforma which included the patient factors (Age, sex, performance status, BMI, substance abuse), HIV related parameters (Time since diagnosis of HIV, baseline CD4 counts, comorbid conditions, treatment with HAART), tumour related factors (Site, type of cancer, subtype, stage, prognostic factors depending on the histology) and treatment aspects (Type of treatment, any requirement of dose modifications, toxicity, response, compliance). Results:The study included 100 patients with HIV and cancer (43 female patients and 57 male patients) with an average age of 42 years. A majority of the patients (71%) were in the 31-40 years age group, as shown in Table 1.The mean BMI of the study group was 19.45 (Range: 10 -26.5). Thirteen of the forty-four patients (29.5 %) had poor general condition with a performance status of 3 or 4 by the ECOG (Eastern Cooperative Oncology Group) scale. All patients were already enrolled for anti-retroviral therapy. The mean time to presentation of cancer after the diagnosis of HIV infection was 5.4 years (Range: 2 months to 15 years). Thirty-two patients had Non-AIDS Defining Cancers (NADC) and twelve had AIDS defining cancers (ADC). Conclusion: In the HAART era, NADCs are more common than ADCs. Standard chemotherapy achieves a response rate of 50% in HIV-NHL cases and 46% in HIV patients with solid cancers. The study illustrates the need for prolonged surveillance for the development of cancer in HIV patients. Early initiation of HAART, optimal chemotherapeutic regimens, appropriate palliative care and nutritional support should form an integral part of the care of HIV patients with cancer