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A clinical overview of people living with HIV and genitourinary cancer care

Nature Reviews Urology (2024)Cite this article

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Abstract

The number of people living with HIV infection has been increasing globally. Administration of antiretroviral therapy is effective in controlling the infection for most patients and, as a consequence, people living with HIV (PLWH) now often have a long life expectancy. However, their risk of developing cancer — most notably virus-related cancers — has been increasing. To date, few studies have assessed the risk of genitourinary cancers in PLWH, and robust scientific data on their treatment-related outcomes are lacking. Previous studies have noted that PLWH are at a reduced risk of prostate cancer; however, low adoption and/or availability of prostate cancer screening among these patients might be confounding the validity of this finding. In genitourinary cancers, advanced stage at diagnosis and reduced cancer-specific mortality have been reported in PLWH. These data likely reflect, at least in part, the inequity of health care access for PLWH. Notably, systemic chemotherapy and/or radiotherapy could decrease total CD4+ cell counts, which could, therefore, increase the risk of morbidity and mortality from cancer treatments in PLWH. Immune checkpoint inhibitors have become the therapeutic backbone for many advanced malignancies in the general population; however, most studies validating their efficacy have excluded PLWH owing to concerns of severe adverse effects from immune checkpoint inhibitors themselves and/or related to their immunosuppressed status. To our knowledge, no genitourinary cancer survivorship programme exists that specifically caters to the needs of PLWH. By including PLWH in ongoing cancer trials, we can gain invaluable insights that will help to improve cancer care specifically for PLWH.

Key points

  • The introduction of highly active anti-retroviral therapy for people living with HIV (PLWH) means that the number of ageing PLWH are increasing, which is associated with increased risks of non-AIDS-defining cancers.

  • The exact risks of genitourinary cancer diagnoses among PLWH are inconclusive; however, the incidence of genitourinary cancers, especially testicular cancer, have been declining since the introduction of highly active anti-retroviral therapy.

  • Guidelines for treatment for the general population are currently used to manage PLWH who have cancer, but concern exists regarding drug–drug interactions and immunodeficiency, which could affect the efficacy of cancer and HIV treatments and increase the risk of treatment-related toxic effects.

  • Health disparities among PLWH persist, especially in African American and Hispanic people, and those from sexual minorities.

  • In spite of intensive efforts to include PLWH in clinical trials, limited studies are ongoing.

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Fig. 1: Forest plots of genitourinary cancer risks in PLWH varied by tumour site and 95% confidence intervals.

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Acknowledgements

The authors thank Public Health and Community Medicine Department at Tufts University School of Medicine for coordinating this review, along with Mrs. Rachel Compitello and Mrs. Chardonnaye K Philon for their assistance.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Chalairat Suk-Ouichai

  2. Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA

    Anna E. Coghill, Matthew B. Schabath & Anna R. Giuliano

  3. Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA

    Julian A. Sanchez

  4. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA

    Jad Chahoud & Philippe E. Spiess

  5. Department of Medical Oncology, Vita-Salute San Raffaele University, Milan, Italy

    Andrea Necchi

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Contributions

P.E.S., C.S.-O., A.E.C., A.N., M.B.S., J.A.S., J.C., A.R.G. contributed substantially to discussion of the content. C.S.-O. wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Philippe E. Spiess.

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Suk-Ouichai, C., Coghill, A.E., Schabath, M.B. et al. A clinical overview of people living with HIV and genitourinary cancer care. Nat Rev Urol (2024). https://doi.org/10.1038/s41585-023-00846-8

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