Antiretrovirals That Restore Immune Function Needed
New data on cancer rates among HIV-positive people "underline" the needfor the development of antiretroviral drugs that "restore immunefunction more effectively" than currently available treatments, MarkWainberg -- director of McGill University's AIDS Centre at the Jewish General Hospital in Montreal, Canada, and former president of the International AIDS Society -- writes in a Washington Post opinion piece.
Asa result of increased life expectancy because of new antiretrovirals,clinicians and researchers are seeing higher rates of several"life-threatening" cancers among people who have been HIV-positive forlong periods of time, Wainberg writes. These cancers include lymphomas,carcinomas and lung cancers, according to Wainberg, who adds thatalthough the "numbers are still relatively small overall, these cancersare occurring with far higher frequency among" HIV-positive people thanamong the general population. One reason for the increase is that HIVcauses a decline in immunological function that "cannot be completelyrepaired" by antiretrovirals, according to Wainberg. Treatment helpsensure that HIV-positive people will not acquire some infections, butthe immune system still might be compromised in its ability to protectagainst cancer, he notes.
According to Wainberg, the increasesin cancer incidence "raise a number of important concerns" -- includingwhether rates of cancer among HIV-positive people will continue toincrease and whether the cancers will be "restricted to certain typesor will diversify." Another concern is related to treatment becausechemotherapy temporarily might prevent the use of antiretrovirals,Wainberg writes, adding that such interruptions in treatment could"lead to renewed replication of the virus and exacerbation" ofprogression to AIDS. In addition, "long-term surveillance" is needed totrack whether people living with HIV for 10 to 25 years will becomemore susceptible to developing cancer as antiretroviral therapyimproves, Wainberg writes.
According to Wainberg, although thenumber of cancers seen among HIV-positive people could "plateau,"widespread "damage" to the immune system already might have occurred inalmost all patients, regardless of when they were diagnosed, by thetime they start antiretroviral therapy. The "changes" the data oncancer "reflect in the evolution of HIV/AIDS as a long-term conditionand in the quality of life of those living with it are vivid remindersthat AIDS remains a fearsome disease, despite all the progress we'veachieved over a quarter-century in therapies, acceptance andawareness," Wainberg concludes (Wainberg, Washington Post, 12/4).
Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser DailyHIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Report ispublished for kaisernetwork.org, a free service of The Henry J. Kaiser FamilyFoundation.