Due to HAART and consequent decline in mortality from infectious complications, HIV patients have an increasing burden of non-AIDS defining cancers. Immunotherapy, consisting of PD1/PDL1 inhibitors, has revolutionized the treatment of cancers but data on their safety and efficacy is unknown in HIV patients, as they were excluded from clinical trials due to concern for unforeseen side effects.
This is the largest retrospective study, involving 17 patients with HIV, treated with one of the 4 PD-1 / PD-L1 inhibitors (Nivolumab, Pembrolizumab, Atezolizumab, Durvalumab or Avelumab) for cancer.The objective of our study was to evaluate the efficacy and safety profile of PD-1 and PD-L1 inhibitors in Cancer patients with HIV and also to assess the impact of these drugs on HIV infection control, specifically CD4 count and HIV viral load.
10 out of 17 patients responded to therapy. Of the 10 patients who responded to therapy,7 were alive and 4 were still on therapy. 10 patients including all 7 non -responders died; 9 died from cancer progression and 1 from sepsis after discontinuing HAART. The minimum duration of response was 15 weeks with one ongoing response at 34 weeks (similar to non HIV patients). Adverse events (Grade 1 or 2) were noted in 7 patients while one stopped therapy due to pneumonitis. CD4 count was stable on treatment and HIV RNA was undetectable (became undetectable in 1 patient with initial low HIV viremia) (Table1).
PD-1 and PD-L1 inhibitors have transformed cancer treatment. Our data shows that they have equal efficacy, tolerable side effects with no effect on HIV markers when used in HIV patients with cancer. We strongly advocate inclusion of HIV cancer patients in clinical trials and support the use of PD1/PDL1 inhibitors in them.
Table 1: HIV markers while on PD-1 or PD-L1 inhibitor therapy
|Patient||CD4 count at initiation of therapy||Viral load at initiation of therapy||CD4 count at 12 weeks of therapy||Viral load at 12 weeks of therapy|
NA- Data not available. *-Died before response could be assessed
Viral Load- copies/ml.
S. Jain, None
C. Hostler, None