HIV and cancer in the Veterans Health Administration System
Semin Oncol. 2019 Aug - Oct;46(4-5):334-340. doi: 10.1053/j.seminoncol.2019.09.007. Epub 2019 Oct 28.
Sigel K1, Park L2, Justice A3.
1. Icahn School of Medicine at Mount Sinai, NY, NY.
2. Stanford University School of Medicine, Palo Alto, CA.
3. VA Connecticut Healthcare System, West Haven, CT; Yale University School of Medicine.
Cancer is a leading cause of death for people with HIV (PWH). The Veterans Healthcare System (VA) is the largest single institutional provider of HIV care in the United States. Cancer among Veterans with HIV is major issue and clinical research has expanded significantly during the antiretroviral therapy (ART) era providing numerous insights regarding cancer incidence, risk factors, prevention, treatment and outcomes for this unique group of patients. This work has been greatly facilitated by the availability of national VA data sources. Notably, patterns of cancer incidence have changed for Veterans with HIV during the ART era; non-AIDS defining malignancies now are the most common tumors. Despite better HIV control in the ART era, immunosuppression measured by low CD4 counts and HIV viremia have been associated with increased cancer risk. Cancer outcomes for Veterans with HIV may now be similar to uninfected Veterans, but information on outcomes and cancer treatment patterns remains limited, requiring further study to help inform prevention and treatment strategies.