Addressing the HIV-Cancer Link – InventUM

Sylvester is taking steps to minimize cancer risks for high-risk HIV patients through education, screening and early detection.

People infected with human immunodeficiency virus (HIV) can largely control its devastating effects on health and extend their lives with approved antiretroviral therapies. However, effective HIV control does not reduce the higher risk of cancer in people with HIV.

“HIV drugs can be great,” said Isabella Rosa-Cunha, MD, a researcher at Sylvester Comprehensive Cancer Center and associate professor of infectious diseases at Sylvester Comprehensive Cancer Center. By properly controlling the immune system, these individuals should theoretically be no more susceptible to malignancy than others.” University of Miami Miller School of Medicine. “This may be true for most cancers, but certain types of cancer affect people living with HIV more than the general population.”

Sylvester Fellow Dr. Emmanuel Thomas, MD, PhD, who was named a National Institutes of Health (NIH) investigator in 2022, said factors that increase cancer risk include nonadherence or lack of access to HIV treatment; People living with HIV age. NIH) Mixed Infections and HIV-Related Cancer Research Section.

An immune system weakened by years of fighting HIV may also be susceptible to mutations at the cellular level and predispose to certain types of cancer, Dr. Rosa-Cunha said. She joined Sylvester’s colleagues in the AIDS Malignancy Consortium, a division of the National Cancer Institute (NCI) dedicated to studying malignancies in people living with HIV.

HIV, cancer link in South Florida

Concerns about increased cancer risks are particularly acute in South Florida. For example, Miami-Dade County is the epicenter of the HIV/acquired immunodeficiency syndrome (AIDS) epidemic in the United States, accounting for one-third of new HIV diagnoses in Florida.

“The reasons for this are complex, including that we are home to many racially, ethnically and gender-distinct risk groups,” said Dr. Thomas. “Given the diversity of South Florida’s population, HIV prevention presents significant challenges. “

Three HIV-related cancers—Kaposi’s sarcoma, B-cell non-Hodgkin lymphoma, and cervical cancer—define AIDS and mark its progression. According to the NCI, people living with HIV are 500 times more likely to be diagnosed with Kaposi’s sarcoma and 12 times more likely to be diagnosed with non-Hodgkin’s lymphoma, and among women, Three times more likely to be diagnosed with cervical cancer.

People living with HIV are also at higher risk for non-AIDS-defining cancers, including anal, liver, oral/pharyngeal, lung, and Hodgkin lymphoma.

look at the problem carefully

Viruses that can coexist with HIV can cause many non-AIDS-defining cancers, Dr. Thomas said.

“HIV weakens the immune system, reducing the body’s ability to fight viral infections that can lead to cancer,” he said. “These cancer-causing viruses include Epstein-Barr, human papillomavirus (HPV), and hepatitis B and C.”

Herpesvirus type 8 can cause Kaposi’s sarcoma, Epstein-Barr virus can cause non-Hodgkin’s lymphoma, HPV can cause cervical, anal and oropharyngeal cancers, and hepatitis B and C are linked to liver cancer, Dr. Thomas said. Related.

Controlling the Threat of Cancer

Sylvester is addressing HIV cancer through programs focused on HIV prevention, antiretroviral treatment, and cancer screening for people living with HIV. Its Game Changer vehicles provide HIV testing and screening for related cancers, including cervical cancer, blood cancers and rare skin cancers such as Kaposi’s sarcoma.

“We have three mobile units that go into communities across our district, from Palm Beach County to Key West, to provide a variety of cancer screenings,” said Director Valerie Bethel, Ph.D., MBA/HCM, BSW. Sylvester’s Office of Outreach and Engagement. “We offer HIV and hepatitis testing to individuals who may be at higher risk for contracting these diseases. “We also work with other community partners and our sister program the Miami AIDS Center to recommend PrEP (Prevention to Prevent HIV Infection) if needed customer of. “

Sylvester’s community outreach program provides counseling and referrals to local resources and cancer prevention services, and Dr. Thomas helped start a program at the University of Miami’s UHealth Tower Emergency Department to screen patients for HIV and hepatitis C.

“Patients can be tested for both viruses at no charge while they are receiving needed care in the emergency room,” said Dr. Thomas. “This program helps us identify patients with HIV who don’t know they are infected so we can notify them and provide them with care. service. It also identifies people with HIV who are not receiving appropriate treatment, so we can help them manage their HIV.”

Sylvester researchers are involved in studies focused on preventing cancers, such as anal cancer, that more commonly afflict people with HIV.

Dr. Rosa-Cunha led the national ANCHOR study at Sylvester and Jackson Memorial Hospital, which found that treating precancerous anal lesions significantly reduced the risk of anal cancer in people living with HIV. The results of a study of more than 10,000 people at high risk for cancer were published in the New England Journal of Medicine.

“Sylvester established the only program in South Florida specifically targeting anal dysplasia to prevent anal cancer,” said Dr. Rosa-Cunha.

Dr. Thomas’ laboratory is studying liver cancer biomarkers, including TREM-1.

“TREM-1 is associated with the development of liver cancer, so we sought to understand this molecule and its role in liver cancer development in order to use it as a biomarker to identify patients with hepatitis C and HIV who may have increased rates of infection .risk of liver cancer,” Dr. Thomas said.

Cancer prevention in people living with HIV

Dr. Thomas believes that the first step in effective prevention is adherence to antiretroviral therapy.

“Well-controlled antiretroviral therapy certainly protects against Kaposi’s sarcoma,” he said.

The HPV vaccine is effective and is recommended for eligible patients, as is regular screening for cervical and anal cancer. “Patients with co-infections should be closely monitored for these cancers,” Dr. Thomas said. “In the case of hepatitis C, this is a curable virus. The best thing we can do for them is to cure hepatitis C, thereby significantly reducing their risk of liver cancer.”

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Label: Dr. Shria Kumar, HIV, Sylvester Comprehensive Cancer Center