Abbar Baptiste, Veyri Marianne, Solas Caroline, Poizot-Martin Isabelle, Spano Jean-Philippe
AP-HP, Sorbonne Université, Inserm, institut Pierre Louis d'épidémiologie et de Santé Publique, équipe Theravir, hôpitaux universitaires Pitié Salpêtrière - Charles-Foix, oncologie médicale, 75013 Paris, France.
AP-HM Timone, service de pharmacocinétique et toxicologie, Inserm 1207, IRD 190, EFS IRBA, unité des virus emergents, Aix Marseille université, Marseille, France.
Bull Cancer. 2020 Jan;107(1):21-29. doi: 10.1016/j.bulcan.2020.01.001. Epub 2020 Jan 21.
The HIV infection remains a serious public health concern in France and around the world. Cancers are frequent among people living with HIV (PLWH) and have become the leading cause of mortality among this population in France. Certain non-AIDS-defining cancers are much more common among PLWH, such as anal carcinoma, Hodgkin lymphoma, hepatocellular carcinoma and lung cancer. The incidence of cancer among PLWH depending on various factors, virological control under combined antiretrovial therapies (cART), exposure prevention to oncogenic virus and toxics are of utmost importance, such as the implementation of specific screening programmes. Drug interactions between cART and oncologic treatments can lead to serious adverse effects or to a reduction in the therapeutic effects, therefore they require a close monitoring. The PLWH have been excluded from the oncologic clinical trials assessing the efficacy and toxicity profile of the immune checkpoints inhibitors (ICPi) because of an increased theoretical risk of inducing adverse events and a feared lack of efficacy in the immunocompromised population. However, the mostly retrospective clinical data reporting the use of ICPi among PLWH are somewhat reassuring with a safety and efficacy profile similar to what observed in HIV-negative patients. Regarding the "shock and kill" anti-HIV effects of ICPi, the preliminary clinical data available are still modest and relatively disappointing despite encouraging results obtained in vitro. HIV-associated cancers represent a particular care challenge due to the multiple comorbidities in the population and the high risk of drug interactions, thus the CANCERVIH national network is of particular interest within this context.
在法国乃至全世界，艾滋病毒感染仍然是一个严重的公共卫生问题。癌症在艾滋病毒感染者（PLWH）中很常见，并且已成为法国这一人群中的主要死因。某些非艾滋病定义性癌症在PLWH中更为常见，如肛门癌、霍奇金淋巴瘤、肝细胞癌和肺癌。PLWH患癌症的发生率取决于多种因素，联合抗逆转录病毒疗法（cART）下的病毒学控制、对致癌病毒和毒物的暴露预防至关重要，例如实施特定的筛查计划。cART与肿瘤治疗之间的药物相互作用可能导致严重不良反应或治疗效果降低，因此需要密切监测。由于理论上诱导不良事件的风险增加以及担心免疫功能低下人群缺乏疗效，PLWH被排除在评估免疫检查点抑制剂（ICPi）疗效和毒性特征的肿瘤临床试验之外。然而，大多数报告PLWH使用ICPi的回顾性临床数据在安全性和疗效方面与在艾滋病毒阴性患者中观察到的情况相似，这在一定程度上令人放心。关于ICPi的“休克并杀死”抗艾滋病毒作用，尽管在体外获得了令人鼓舞的结果，但现有的初步临床数据仍然有限且相对令人失望。由于该人群存在多种合并症以及药物相互作用风险高，艾滋病毒相关癌症带来了特殊的护理挑战，因此在这种背景下，CANCERVIH国家网络特别值得关注。
