NCCN Guidelines for Cancer in HIV: A Quiz

Take this 5-question quiz to test your knowledge of the latest National Comprehensive Cancer Network (NCCN) guidelines for cancer in patients with HIV infection.

Question 1.

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Answer: B. Anal cancer

According to the 2018 NCCN guidelines, the following are AIDS-defining malignancies: cervical cancer, Kaposi sarcoma, and aggressive non-Hodgkin lymphoma. The following are non–AIDS-defining malignancies: anal cancer, non–small cell lung cancer, Hodgkin lymphoma, and other non–AIDS-defining malignancies such as prostate cancer, liver cancer, colorectal cancer, oral/pharyngeal cancer, and breast cancer.¹

Question 2.

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Answer: D. Lung cancer

According to the NCCN, the most common malignancy in patients with HIV infection is lung cancer; their risk is 2 to 5 times higher than that of the general population. The prevalence of smoking is higher in persons living with HIV, which likely contributes to their higher risk of lung cancer. Immunosuppression is another contributing factor. Patients who smoke and are receiving antiretroviral therapy (ART) have a 6 to 13 times higher likelihood of dying of lung cancer than AIDS-related causes. The NCCN recommends that persons with HIV infection should be screened for lung cancer using the same criteria as for the general population.¹

Question 3.

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Answer: A. True

According to the NCCN and the CDC, all patients in whom cancer is diagnosed who do not already have documented HIV positivity should be tested for HIV and referred to an HIV specialist if they test positive. Doing so can improve linkage to HIV care, enable early ART initiation, and improve survival.¹ As of 2017, about 1.1 million people in the US were living with HIV, and this group may have up to a 50% higher incidence of cancer, compared with the general population.²

Question 4.

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Answer: D. Both B and C

According to the 2018 NCCN guidelines, ART should be offered immediately to patients who are not already receiving it. However, providers should consider starting ART 7 or more days before or after the start of cancer therapy to provide enough time for tolerance to either therapy to be established. ART may also need to be adapted in accordance with cancer therapy. ART should not be interrupted during cancer therapy because doing so can increase the risk of immunologic compromise, opportunistic infections, and death.¹

Question 5.

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Answer: C. Substitute a different antiretroviral with less potential for drug-drug interactions

According to the 2018 NCCN guidelines, the following treatment options should be considered, ranked in order of priority, in patients with HIV infection who are being treated for cancer and for whom a drug-drug interaction exists¹:

1. Substitute a different antiretroviral with less potential for drug-drug interactions
2. Use an alternative cancer therapy with less potential for drug-drug interactions
3. Temporarily discontinue ART, but only in consultation with an HIV specialist and only if:
• Numbers 1 and 2 are not advisable, the aim of treatment is curing malignancy, and the patient is undergoing a short course of chemotherapy
• Numbers 1 and 2 are not advisable, the cancer has a poor prognosis, and the goal of treatment is palliation

References:

1. Reid E, Suneja G, Ambinder RF, et al. Cancer in People Living With HIV, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018;16:986-1017. doi: 10.6004/jnccn.2018.0066.

2. Robbins HA, Pfeiffer RM, Shiels MS, et al. Excess cancers among HIV-infected people in the United States. J Natl Cancer Inst. 2015;107(4). pii: dju503. doi: 10.1093/jnci/dju503. Print 2015 Apr