Abstract
Background: To synthesize published literature on the association between human immunodeficiency virus (HIV) infection and radiation therapy (RT)-related toxicities.Methods: Two electronic databases, MEDLINE and Embase, were searched to identify studies published before November 2016 comparing RT-related toxicities between HIV-infected and HIV-uninfected patients receiving RT or chemoradiation therapy (CRT) for cancer. A qualitative synthesis of included articles and organ-specific toxicities was then performed.Results: Of the 21 studies included in this review, 15 reported on anal cancer treatment, three on cervical cancer, two on Kaposi sarcoma, and one on prostate cancer. Reports in the pre-antiretroviral therapy (ART) or early ART era tended to identify increased morbidity and mortality with HIV infection. However, modern series incorporating more concurrent chemotherapy, conformal RT techniques, and ART administration result in fewer studies reporting toxicity differences in patients treated for anal and cervical cancers. When statistically significant, HIV-infected patients had higher rates of gastrointestinal toxicity with anal cancer CRT (up to 50%) and higher rates of hematologic toxicity with cervical cancer CRT (up to 31%). Of the 17 studies reporting treatment outcomes, nine suggest HIV-infected patients may have reduced local control and/or survival rates.Conclusions: Overall, RT is likely similarly tolerated between HIV-infected and HIV-uninfected patients, especially with modern RT techniques. HIV-infected patients should continue to receive established standard of care RT and CRT dosing.
Highlights
The global prevalence of cancer in people infected with human immunodeficiency virus (HIV) is increasing in parallel with the increased availability of cancer treatment worldwide
Syndrome (AIDS) defining cancers (ADCs) such as Kaposi sarcoma and non-Hodgkin lymphoma have decreased with expanding access to HIV antiretroviral treatment (ART) (1–3)
Eleven unique studies were identified during full text article review and assessed for inclusion in the review
Summary
The global prevalence of cancer in people infected with human immunodeficiency virus (HIV) is increasing in parallel with the increased availability of cancer treatment worldwide. This has led to an increasing number of patients with HIV-associated malignancies receiving radiation therapy (RT) and chemoradiation therapy (CRT). There is a higher rate of NADCs among HIV-infected patients compared to HIV-uninfected patients (4). Given the significant burden of malignancy among people living with HIV, and that approximately half of all cancer patients receive RT at some point during their disease course (6–8), determining the impact of HIV infection on RT-related toxicity is crucial. To synthesize published literature on the association between human immunodeficiency virus (HIV) infection and radiation therapy (RT)-related toxicities
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