The British HIV Association (BHIVA) has issued draft guidelines on the management of cancer in people with HIV infection which can downloaded from the BHIVA website. The consultation period ends on October 19th.
Although the incidence of two of the three AIDS-defining cancers (Kaposi's sarcoma and non-Hodgkin’s lymphoma) appears to have been reduced in the era of potent antiretroviral therapies, there does not appear to have been a similar reduction in the incidence of CIN and invasive cervical cancer.
In addition, there is mounting evidence (see, for example, recent reports from ICAAC and IAS) suggesting that the incidence of certain non-AIDS-defining cancers is increasing, possibly due to factors associated with long-term immunosuppression.
Consequently, BHIVA’s draft guidelines on the clinical care of HIV-positive individuals with cancer appear both necessary and timely. The guidelines synthesise the latest research and clinical experience in the areas of oncology, haematology and HIV, and also include input from the community of people living with HIV in the UK.
“The clinical care of patients with these tumours requires a multidisciplinary approach drawing on the skills and experience of all healthcare professional groups,” the guidelines note. “Moreover, optimal care can only be achieved by the close co-operation of oncologists, haematologists and HIV physicians, and unless all these clinicians are intimately involved in the care of patients it is likely that the outcome will be less favourable.”
The guidelines cover in great detail the diagnosis and treatment of the many variations of the three AIDS-defining cancers as well as the following non-AIDS-defining cancers: AIN and anal cancer; Hodgkin’s lymphoma; Castleman’s disease; testicular cancer; lung cancer; and liver cancer.
They also provide detailed guidance on the use of individual antiretrovirals and opportunistic infection prophylaxis in HIV-positive individuals being treated for cancer.
General recommendations
The guidelines’ authors make some general recommendations on the management on cancer in people with HIV in the United Kingdom.
These include:
- All patients with HIV and malignancy should be referred to centres that have developed expertise in the management of these diseases and serve an HIV cohort of >500.
- The multidisciplinary medical team managing these patients must include HIV physicians, oncologists, haematologists and palliative care physicians.
- In line with national cancer waiting times, all patients with suspected cancers must be referred urgently and seen within two weeks of referral.
- No patient should wait longer than one month from an urgent referral with suspected cancer, to the start of treatment.
The consultation period ends on 19th October 2007. Please forward any comments to the BHIVA Secretariat via the form on the BHIVA website.
Bower M et al. BHIVA guidelines: HIV associated malignancies (2007).
Available as a pdf download from the BHIVA website.