HIV and melanoma

Lorenzo Alonso

Reunión GEAM

¿Why to speak about HIV and melanoma?

• There is a deterioration in the immune system in HIV patients.

• Immune deficits are associated to an increase in cancer incidence (transplant recipients)

• Melanoma is a very immunogenic tumor• Is there an incidence increase of

melanoma in HIV patients?

AIDS. 2009 January 28; 23(3): 385–393. doi:10.1097/QAD.0b013e3283213046.

JNCI 2013; 105: 350-360Arch Dermatol. 2010;146(6):625-632

A BC

D

E

A, B , C: Merkel cell carcinoma

D.Appendageal carcinoma

C: squamous and basal cell carcinoma

Int. J. Cancer: 13, 187–194 (2008)

melanoma incidence (registries USA)

melanoma incidence: Navarra (Spain)

ASSOCIATION HIV/AIDS and melanoma

Situación pRR 95% CI Significado

PreHAART 1,26 1,11-1,43 + 26%

etnicidad

PostHAART

etnicidad

SIDA

1,28

1,26

1,50

1,07

1,1- 1,49

0,97- 1,64

1,12- 2,01

0,83- 1,39

+ 28%

+26%

+50%

CLINICAL PRACTICE AND MELANOMA

Clinical Trials exclude HIV patients with melanoma

CTLA-4:Inverse correlation with CD4 levels and viral load.

Upregulated inn HIV.

AIDS 2002; 16(4): 519

Burke M M et al. JCO 2011;29:e792-e794

©2011 by American Society of Clinical Oncology

“MODEL PATIENT FOR TREATMENT”

. ECOG 0-1

. Young

. Low viral load

. CD4>500 mm3

. No bulky disease

, Slow clinical agresiveness

Conclusions

• 1. There is a relative increase of the incidence of melanoma(20-50%) in HIV patients.

• 2. Melanoma and HIV a diagnosis challenge: other cutaneous tumors and special locations

• 3. The uncertainty to treat a patient with melanoma and HIV is very similar to a patient without HIV.