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Invited Commentary
December 5, 2019

Untangling the Effects of Chemotherapy and HIV on CD4 Counts—Implications for Immunotherapy in HIV and Cancer

Author Affiliations
  • 1Department of Medicine, Allergy and Infectious Disease Division, University of Washington, Seattle, Washington
  • 2Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 3Uganda Cancer Institute, Kampala
  • 4Department of Medicine, Medical Oncology Division, University of Washington, Seattle, Washington
JAMA Oncol. 2020;6(2):235-236. doi:10.1001/jamaoncol.2019.4634

Therapies for HIV infection and cancer have evolved exponentially during the past 20 plus years. The year 1996 marked the availability of 3-drug combination antiretroviral therapy (ART); in 1997, rituximab was approved as the first monoclonal antibody for the treatment of cancer. Despite advances in both fields during the ensuing decades, a question remains as to whether we are optimizing meaningful therapeutic advances for people living with HIV and cancer. Treatment of HIV-associated malignant neoplasms underwent a major paradigm shift with the introduction of ART. Before effective HIV therapy, many cancer treatment regimens in people living with HIV were dose reduced and largely palliative. However, availability of ART and associated immune reconstitution led to a series of studies that demonstrated that many people living with HIV were able to tolerate standard cancer therapies and, with the exception of those with very low CD4 counts (eg, <50-100 cells/μL), often had outcomes comparable to those of the general population. Despite improved cancer outcomes, many early ARTs had toxic effects that overlapped with cancer therapies. Furthermore, an important class of ART, protease inhibitors, has clinically significant CYP3A4-mediated drug-drug interactions that may increase the toxic effects of many common antineoplastic agents.

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