I attended the most recent BC Centre for Excellence in HIVAIDS (BCCfE) Antiretroviral update yesterday, and as usual, had lots to think about once the day concluded. Presentations covered cancer and HIV; cardiovascular disease risk and management; harm reduction and opioids; PEP guidelines and best practices.
This post summarizes the morning’s information and community takeaways on cancer and cardiovascular disease. Part 2 summarizes points on harm reduction and opioids; PEP guidelines and best practices; and the BCCfE update.
To sum up the morning’s overall message, it was one of humility and curiousity. Doctors admitted that while they know a lot about HIV, there is still a lot more research to be done. Treatment leaps and bounds have led us here, yet there is still a distance to travel in understanding how HIV interacts with other diseases, especially as people with HIV live longer.
Cancer and HIV
Dr. Kate Salters provided an overview of cancer in people with HIV, saying the relationship of HV and cancer is “quite complex” and as yet, not entirely understood. As populations of people with HIV (PLHIV) are aging, there is an increase in comorbidities like cancer. In general, the incidence of cancer in PLHIV is twice that of comparable populations who are uninfected.
Is cancer in PLHIV a result of living longer with HIV? Research isn’t clear on this. The history of treatment that lead to increased longevity is still too new to draw conclusions. Doctors do know that the sooner people start on ART, there are better outcomes regarding progression of infection related cancers like HPV (anal and cervical). While non AIDS defining malignancies are increasing over time, they come at a later time after diagnosis than they used to.
Dr. Janice Leung spoke about lung cancer and HIV. If HIV induced immunosuppression shows lower CD4 counts, there is a higher risk of cancer. Smoking is an obvious risk factor, and a third of people with HIV make no attempt to quit after HIV diagnosis. Leung pointed out that HIV doctors aren’t sufficiently screening patients for lung cancer: “That’s on us,” she said.
Do people with HIV get lung cancer earlier than their uninfected peers? Yes, but there is only a five-year difference in diagnoses. However, by one year after a lung cancer diagnosis, 57% of people with HIV will have died.
Why? Leung said that people with HIV are at risk of never receiving treatment: two and a half times at risk, in fact. Oncologists may have concerns about the impact of treatments; surgeons may have concerns about the benefits of interventions vs their risks. There is not enough data, but what is known is that even patients who receive treatment appropriate to the stage of their cancer do worse overall. Leung finished her presentation with some discussion about merits of various types of screening, but concluded that doctors don’t know if established screening guidelines are appropriate for people with HIV. More study needs to be done, as is often the case. To note is that there’s no data on cannabis smoking, although assumption is made that if you’re smoking cannabis you’re smoking cigarettes.
Cardiovascular Disease in HIV
Dr. Greg Bondy spoke about the relationship of cardiovascular disease (CVD) to HIV. The good news is that antiretroviral treatment (ART) has decreased deaths related to cardiovascular disease, but CVD is still an issue for PLHIV. Rates of heart disease for people with HIV are “ten years ahead of the curve.”
HIV is an inflammatory disease, and though ART can reduce inflammation, controlling it in relation to cardiovascular health remains a challenge. Despite best efforts, markers for inflammation remain elevated beyond normal ranges of uninfected people. Bondy suggested that standard cardiovascular risk calculators underestimate the risk in people with HIV and clinicians must take a conservative approach rather than relying on these models of measurement. Assessments for heart disease should always include family histories (if they’re known).
What We Can Do in Community
For those working in community support and education, the takeaway message is to encourage clients and members to learn as much as they can so they can work with their doctors. Doctors may not take the time nor have the skills to explain everything, so community based education sessions on the comorbidities of HIV, delivered in ways people can understand, can improve health literacy and patient-doctor successes.
NOTE: Slides from the ARV Update are available on the BCCfE website. Any errors in information are mine, and this post and its partner Part 2 can’t be taken as medical advice.
BCCfE Update Part 2: Harm Reduction in Prisons; Opioids; PEP and PrEP
Questions? Feedback? Get in touch!
Janet Madsen, Capacity Building and Knowledge Translation Coordinator,
[email protected]