HIV weakens the immune system over time, leaving people with the virus susceptible to developing malignancies such as Kaposi sarcoma and lymphomas, but also more common cancers as they age.
Patients living at this unique intersection of HIV and cancer face complex medical challenges, and traditional cancer care pathways often do not effectively address the specific needs of individuals with HIV. Brinda Emu, MD, PhD, associate professor of medicine (infectious diseases), and Jill Lacy, MD, professor of medicine (medical oncology), realized that a dedicated effort was required to offer comprehensive care, as well as investigate the scientific underpinnings of these conditions.
Last year, Yale launched the Cancer-Infectious Diseases (Cancer-ID) program, a pioneering new initiative combining specialized patient care with critical research. The program is a joint effort between the Department of Internal Medicine’s Section of Infectious Diseases, Yale Cancer Center, and Smilow Cancer Hospital.
Emu and Lacy have dedicated their careers to studying the relationship between HIV and the immune system.
Patients with uncontrolled HIV can develop rare, life-threatening cancers. These diseases, known as “AIDS-defining malignancies,” were highly prevalent during the AIDS epidemic. Lacy remembers a time when AIDS-defining malignancies were the dominant concern.
"In the earlier years of the epidemic, we had a dedicated focus on AIDS-defining malignancies like Kaposi sarcoma and lymphomas,” Lacy said. “But as the field of HIV care evolved, that specific focus became less pronounced. Our patients were now at risk for all types of cancers."
Now, with improved HIV treatments, patients have been living longer and can avoid developing AIDS-defining malignancies.
"My training had focused on understanding the immune response to viruses, particularly HIV,” Emu said. “As HIV therapies improved over time, the urgent need to understand these immune responses seemed to recede. But something became glaringly evident – patients with HIV were grappling with a new set of challenges, including non-AIDS related conditions like cancer."
In its inaugural year, the clinic had already made significant strides. One of its core missions was to bridge the gap in communication between HIV and oncology physicians.
“We decided to house the clinic within infectious disease, which is where most HIV patients are seen,” Emu said. “But our collaboration with oncology was paramount. We identified oncologists in various specialties to be part of our clinical team. This allowed us to offer disease-specific expertise while maintaining a holistic approach to patient care."
This unique clinic wasn't just a space for patients to receive care. Through the Cancer-ID Program, doctors and researchers spanning infectious diseases and oncology collaborate to tackle questions in basic science and health services.
One major area of exploration revolved around the interplay between HIV, cancer, and social determinants of health. The clinic had identified an array of issues outside of cancer clinical care that profoundly affected patient outcomes – financial struggles, psychiatric challenges, housing issues, food insecurity, and insurance-related complexities.
"Our patients often face multiple barriers to care, and these can have a significant impact on their overall health and well-being,” Emu said. “We've received grants to delve deeper into these social determinants of health, with the hope of not only improving the patient experience but also enhancing clinical outcomes."
Additionally, researchers in the Cancer-ID Program seek to uncover more information about drug-related interactions between antiretroviral therapies used in HIV and cancer treatments.
"Patients often experience unique challenges related to overlapping toxicities of their medications,” Lacy said. “By studying these complexities more systematically, we hope to find ways to mitigate these issues, ultimately improving their quality of life during cancer treatment."
Moving forward, investigators will consider the possibility of further integrating clinical care with open research questions. Although patients with HIV have historically been excluded from clinical trials, the Cancer-ID Program could offer a platform for researchers to specifically study questions tailored to this population.
The Department of Internal Medicine’s Section of Infectious Diseases engages in comprehensive and innovative patient care, research, and educational activities for a broad range of infectious diseases. Learn more at Infectious Diseases.