The clinical management of cancer in HIV positive patients is associated with challenges mainly due to the state of their immunity. As the National Emergency Response Council on HIV/AIDS (NERCHA), it is prudent that we draw People Living with HIV (PLHIV) and the general public to the need for constant screening for cancer and other chronic illnesses, to curb unfortunate incidents of resistance to treatment and unnecessary deaths. Part of NERCHA’s mandate is to facilitate coping mechanisms by providing education, promote awareness and offer hope and encouragement to our staff and their families on how to deal with cancer. The main modalities of managing cancer are surgery, chemotherapy and radiotherapy with most patients requiring combination therapy. These treatment modalities lead to reduced immunity in patients which is further reduced if one or two modalities are combined.
At present, HIV positive patients diagnosed with cancer are being managed using guidelines for managing HIV seronegative patients diagnosed with cancer. The outcomes of treatment in HIV positive patients are worse compared with HIV negative patients, as HIV positive patients present late symptoms but at a higher risks of cervical intraepithelial neoplasia (CIN) and are less likely to complete oncology treatment. Infection with HIV has also been noted to increase mortality among cervical cancer patients generally. Other commonly associated malignancies in the HIV setting include; lymphomas, Kaposis’ sarcoma, anal carcinoma and other HPV associated malignancies like vulval and penile cancers.
Having HIV raises your risk for AIDS-related cancers. In fact, Kaposis sarcoma is rare in people who don’t have HIV. HIV is linked to a higher risk for certain types of cancer. But AIDS-related cancers have become less common. This is likely because people are getting antiretroviral drugs. Fortunately, enough for Eswatini, most PLHIV are on HIV treatment and virally suppressed, which has become a huge milestone achieved way ahead of many other countries. Patients with compromised immunity usually suffer more treatment toxicities as well. Chemo-radiotherapy used in the treatment of cervical cancer affects the immune status of patients. Chemotherapy leads to immune cells suppression and the toxicity following radiotherapy is increased in patients with compromised immunity.
Eswatini is one of the many countries affected by different types of cancer. Ms Futhi Shongwe, a young person living with HIV, who is also the Program Manager of the Swaziland Young Positives (SYP) says as one of the Women Living with HIV (WLHIV) and surviving cervical cancer since 2017, it hasn’t been an easy road for her. “I have never felt so afraid; the anxiety of not knowing what will happen the next day took a toll at some point. Fear of the unknown even when you have a slight illness, the mind quickly tells you death is nearing,” noted Futhi. “I would like to urge all WLHIV to do cervical cancer screening once a year and ensure that they get their results and take necessary precautions, cancer is real,” she highlighted.