In Reply Dekker’s comments add nuance to our study on the use of the anti–programmed cell death ligand 1 (PD-L1) antibody durvalumab to treat solid tumors in patients with HIV-1 infection,1 especially with regard to the risk of specific adverse events when these patients are also receiving effective antiretroviral therapy (ART). Toxic effects due to anti–programmed cell death 1 (PD-1)/anti–PD-L1 antibodies comprise a broad spectrum of uncommon adverse events. In the case of people living with HIV (PLHIV), one concern about the use of anti–PD-1/PD-L1 antibodies is the possibility of causing an immune reconstitution inflammatory syndrome (IRIS) similar to those episodes observed in 8% to 20% of PLHIV after starting ART.2 Immune reconstitution inflammatory syndrome consists of an exaggerated inflammatory reaction, with a high type I interferon response that occurs when the immune system begins to recover following treatment with ART. Although anti–PD-1/PD-L1 antibodies may potentially cause an IRIS-like syndrome in persons with preexisting subclinical coinfections when chronic immunosuppression linked to advanced cancer begins to restore, previous cancer immunotherapy trials have not shown this phenomenon. Therefore, we concur with Dekker that the risk of developing an IRIS-like syndrome in patients receiving effective ART is probably very low.
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Gonzalez-Cao M, Martinez-Picado J, Rosell R. Safety of Anti–PD-L1 Inhibition in HIV-1–Infected Patients With Cancer—Reply. JAMA Oncol. Published online September 10, 2020. doi:10.1001/jamaoncol.2020.3400
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