Forty years ago, a rare cancer led to the discovery of what would become a global epidemic that we are still battling today. In 1981, clusters of Kaposi sarcoma cases, an until then rare cancer that would eventually be discovered to be caused by a viral, prompted investigations that led to the classification of acquired immunodeficiency syndrome (AIDS) and the eventual discovery of the retrovirus HIV.  The advent of effective anti-retroviral therapy has contributed to a remarkable improvement in survival for persons living with HIV. However, now that more people are living longer with HIV, there is a growing burden of chronic conditions that come with advanced age, such as cancer.

"Cancer is now the second leading cause of death among people living with HIV, and we need to better understand what having two chronic co-morbidities means for patients in terms of appropriate therapy and survival."

- Dr. Anna Coghill, Department of Cancer Epidemiology

“Cancer is now the second leading cause of death among people living with HIV, and we need to better understand what having two chronic co-morbidities means for patients in terms of appropriate therapy and survival,” said Dr. Anna Coghill, an epidemiologist at Moffitt Cancer Center whose work focuses on improving outcomes for HIV-positive cancer patients.

Coghill is working with Moffitt clinicians and researchers to build an infrastructure that can help better identify Moffitt cancer patients who are also HIV-positive. This work builds on efforts of clinicians such as gastrointestinal surgeon Dr. Julian Sanchez who treats a large number of HIV-infected men with anal pre-cancer, and researchers like Dr. Anna Giuliano who has pioneered HPV prevention and treatment efforts in high-risk populations and is leading an international research effort to study ways to prevent HPV-related cancers in people living with HIV in Latin American countries. The clear focus on HIV oncology led by Coghill will allow Moffitt to be a leader in providing the best possible care to persons living with HIV and cancer.

One of the first steps is to ensure that all oncologists are aware of cancer patients’ HIV status. Patients can self-report their HIV status during the intake process at Moffitt, but not everyone choses to do so.

“There is a stigma that comes with being HIV-positive, so it is understandable that someone may not want to share their status,” said Coghill. “However, research has shown that cancer patients with underlying HIV infection are more likely to have poor outcomes, so knowledge of patient HIV status is imperative at the start of cancer therapy.” Coghill is therefore working with her colleagues to develop a database that will help identify persons living with HIV receiving care at Moffitt, both to ensure that oncologists are aware of all relevant information and to allow those patients with HIV unique access to clinical trials.

Patients with HIV have long been excluded from clinical trials, especially ones involving immunotherapies that bolster one’s immune system to fight cancer. Moffitt is working to open clinical trials specifically for HIV-positive patients with anal cancer, lymphoma and lung cancer. Moffitt also joined the AIDS Malignancy Consortium (AMC) late last year, a clinical trials network supported by the National Cancer Institute.

“The objective of this consortium it to bridge the gap between persons living with HIV and cancer clinical trials,” said Coghill. “The support we receive from the AMC will allow us to expand our work and offer more innovative trials to our patients.”

Moffitt’s HIV oncology work also expands beyond the walls of the cancer center. Coghill is partnering with Dr. Susan Vadaparampil in Moffitt’s Office of Community Outreach, Engagement and Equity to work directly with organizations that serve persons living with HIV to develop strategies to improve cancer prevention, screening and treatment approaches and bring clinical trial access for this patient population to the Tampa Bay region. According to the Centers for Disease Control and Prevention, Florida is third in the nation for number of new HIV diagnoses, and is only surpassed by Washington D.C. and Georgia.

On this HIV testing day anniversary, we want to ensure that everyone knows that HIV is spread through unprotected sexual contact, the sharing of contaminated needles or syringes, infected blood or blood products or mother-to-baby during pregnancy, birth and breastfeeding. We also want everyone to know that the access to effective HIV treatment works to control the virus and eliminate transmission to others. To learn more about the virus or where to get tested, please visit the CDC’s website. For more information on the unique intersection of HIV and cancer, please email HIV@moffitt.org.