Solid malignant neoplasms occurring against the background of HIV infection: diagnosis, treatment, outcomes – the experience of the Tsyb Medical Radiological Research Centre. Observational study

Background. More than 630,000 people die annually worldwide as a result of HIV, while malignant neoplasms (MN) are steadily coming to the fore among the causes of death. At the moment, there is not enough data on the treatment of HIV-infected cancer patients.

Aim. To analyze the experience of treating HIV-infected patients with solid MN who underwent therapy at the Tsyb Medical Radiological Research Centre from 2018 to 2024.

Materials and methods. The study included 154 patients, median follow-up – 35 months. The average age of the patients was 45.4 (30–78) years; 86 (55.8%) women prevailed. The following diagnoses were most often made: cervical cancer (n = 30, 19.5%), thyroid cancer (n = 22, 14.3%), breast cancer (n = 16, 10.4%), head and neck tumors (n = 24, 15.6%). In half of the patients, early stages (I–II) of MN were confirmed – 78 (50.6%), generalized tumor process in the onset of MN was observed only in 34 (22%) patients. The majority of patients – 136 (88.3%) had AIDS. HIV infection was confirmed at various times before the development of MN – from 6 to 279 months, on average after 114 months. The majority of patients have stage 4 HIV – 124 (80.6%). Suppressed viral load – less than 50 copies of viral RNA in 1 ml of blood, was detected in 96 (62.3%) patients. At the time of the start of specific antitumor treatment, the vast majority of patients – 132 (85.7%) have received antiretroviral therapy (ART), another 22 (14.3%) patients started taking ART after an oncological diagnosis. The level of CD4+ cells at the onset of MN was determined in all patients, ranged from 54 to 1036 cells/ml, with an average value of 454 and a median of 401 cells/ml. There were 12 (7.8%) patients with CD4+ cell count less than 200 per µl. Viral hepatitis (B or C) was previously detected in 24 (15.6%) patients, tuberculosis – in 6 (3.8%).

Results. Surgical treatment was performed in 82 (53.3%) patients, of which 74 (90.3%) patients received surgery as a stage of program therapy, and for 8 (9.7%) patients surgical treatment was an independent type of therapy. Radiation/chemoradiotherapy was performed in 50 (32.5%) patients, of which 31 patients received it as a stage of program treatment (62%), and for the remaining 19 (38%) patients, radiation treatment was an independent type of therapy. Antitumor drug therapy was performed in 66 (42.8%) patients: neoadjuvant therapy in 12 (18.1%) patients, adjuvant therapy in 22 (33.3%) patients, palliative chemotherapy therapy in 32 (48.6%) patients. Complications of antitumor therapy were observed in 18 (27.3%) patients, complications of surgical treatment were observed in 1 (1.2%) patient, complications of radiation therapy were identified in 14 (36.8%) patients from the EBRT group, complications of chemoradiotherapy were observed in 6 (50%) patients. During the follow-up, 4 (2.6%) deaths of patients with combined pathology were registered: in two cases, death occurred due to the progression of a malignant tumor, in the other two – due to severe infectious complications during antitumor therapy.

Conclusion. Thus, it is possible for oncological patients with HIV to undergo the entire volume of antitumor treatment, equal to that of patients without HIV, which allows achieving the same oncological results. Appropriate therapy becomes possible with adequate prevention of infectious complications, monitoring of ART, and monitoring drug interactions.