SMHS fourth-year addresses disparities in cancer treatment for HIV patients in new initiative

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Fourth-year medical school student Allison Graeter said cancer research has historically excluded those with HIV due to concerns that they would have adverse reactions to treatment, even though experts said these theories have been disproven.

A new initiative from School of Medicine and Health Sciences fourth-year graduate student Allison Graeter is focusing on addressing disparities in cancer treatment for persons living with HIV.

Graeter started CancerFreeHIV in January to raise awareness about people with HIV’s higher risk of cancer and higher cancer mortality rates. CancerFreeHIV shares educational content on Twitter about cancer prevention and screening and urges people with HIV to participate in clinical trials in order to create more medical understanding about how cancer affects people with HIV differently.

People living with HIV have weakened immune systems that cannot effectively fight against cancer cells. Modern treatment can strengthen their immune systems, but people with HIV still face higher cancer mortality rates and are less likely to be treated for cancer, according to CancerFreeHIV’s website.

“Most people don’t realize that they’re still at risk, an increased risk, for cancer as compared to the general population,” Graeter said. “And I think that even people with HIV don’t really know that.”

She said cancer research has historically excluded those with HIV due to concerns that they would have adverse reactions to treatment, even though experts said these theories have been disproven.

Graeter said organizations like the American Society of Clinical Oncology and Friends of Cancer Research in recent years have pushed for more inclusion of those with HIV in cancer research. But she said searching “HIV” on the U.S. National Library of Medicine-run clinical trial search tool brings up clinical trials that list HIV under exclusions, makes searching for trials that include people with HIV difficult.

“There’s no good reason to just blanket exclude them,” she said. “And when that happens, you’re impairing drugs that could be really effective to treat cancer in people living with HIV from actually getting approved to treat those patients.”

She said CancerFreeHIV is currently working with Carebox, an organization that helps connect patients to clinical trials, to develop a clinical trial search tool for people with HIV to get involved in clinical trials for cancer treatment. Graeter said the search tool will be made available on CancerFreeHIV’s website within the next few weeks.

Graeter said individuals who want to help this effort can share the information posted on CancerFreeHIV’s Twitter and speak up about HIV stigma and the importance of cancer screening.

“I’m very excited to work with people and get others engaged,” she said. “But this is definitely something I want to grow and I want people to be engaged on and be passionate about.”

Jessica Castilho, an assistant professor of medicine and health policy at Vanderbilt University, said she was “really excited” when she found CancerFreeHIV’s Twitter and saw young people recognizing and addressing the dangers cancer poses to people living with HIV.

“I love the content that they’re putting out,” she said. “I think advocacy for people with HIV to be included in cancer research is really important.”

Castilho said people with HIV have always been at higher risk for certain cancers, particularly ones related to the immune system. She said people with HIV live longer lives today due to more effective HIV treatment, but have been found to have an increased risk of cancers not directly linked to the immune system, like lung, liver and anal cancer.

She said cancer prevention efforts, like quitting smoking, finding a healthy diet and exercising, are crucial for people living with HIV because the outcomes of their cancer treatment can be worse than average and lead to increased mortality rates.

“What I tell my patients living with HIV is that it’s actually now twice as important that they quit smoking,” Castilho said.

Brinda Emu, an associate professor of internal medicine at Yale University, said she studies why people with HIV are at a higher risk for cancer, specifically looking at the effects of chronic viral infection on the immune system’s biology, and how cancer differs in people living with HIV.

She said the phenomenon is understudied, so researchers do not know why cancer treatment outcomes differ between people with HIV and those without. Emu said physicians often approach cancer treatment differently for patients with HIV, largely due to concerns that cancer treatments could interfere with HIV medication, but cancer treatment outcomes are still poorer for people with HIV than those without when their situations are comparable.

“I absolutely believe that patients with HIV need to be included in all clinical trials for cancer,” Emu said.

She said Yale will open an integrated HIV and cancer clinic in the next two months where patients will receive care from both oncologists and HIV specialists, which will allow oncologists to better understand HIV and help patients with HIV and cancer to participate in more clinical trials.

“It’s really well supported by our infectious disease group and our cancer center,” Emu said. “And we hope that it’s going to be a model for cancer care going forward.”

Rachel Bender Ignacio, an assistant professor of allergy and infectious diseases at the University of Washington, said the number of cancer screenings that people with HIV patients undergo has decreased because both physicians and patients expect that their lifespan will be shortened. She said CancerFreeHIV’s website provides “well researched and referenced” resources on issues including screening.

“I think it’s really comprehensive and really, really beautiful, and could be a really helpful tool for people,” she said.

Bender Ignacio said collaboration between HIV and cancer specialists can provide solutions whenever there are concerns about drug interactions during clinical trials.

“Through conversation between specialists, somebody could have their regimen changed, or make a comprehensive plan in order to be able to get people on trial,” she said. “So there’s no reason to categorically exclude people.”

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