Head and neck squamous cell carcinoma in HIV patients

Abstract

Purpose of reviewThe introduction of antiretroviral therapy has significantly impacted the incidence of head and neck squamous cell carcinoma (HNSCC) in people living with HIV (PLWH). This manuscript aims to give an overview of the evidence in the literature about this population. Recent findingsPLWH have an increased incidence of HNSCC, with earlier age and more advanced stage at diagnosis. This epidemiologic trend may be explained by combining traditional and HIV-related risk factors. With the improvement of global health status, more patients are candidate for complex therapeutic strategies with curative intent. To date, it is still debated whether HIV-infected patients possess a profile of increased risk regarding treatment-related toxicity and survival outcomes, with the literature still lacking substantial evidence. Among the prognostic factors that can guide the clinician in selecting the most appropriate treatment strategy, age, site/subsite, stage, HIV viral load, and CD4þ T-cell count at diagnosis are the most relevant. SummaryPathogenesis, treatment characteristics, oncologic outcomes, and prognostic factors of HNSCC in PLWH are still debated. Given the increasing incidence of HNSCC in PLWH, the need for dedicated evidencebased studies represents a significant research gap to be addressed.

HPV-associated oropharyngeal carcinomas in patients living with HIV on long-term antiretroviral therapy: Case reports

“…8 Over a 10-year study, the persistence of oncogenic oral HPV (oncHPV) was examined, revealing rapid clearance for most incident infections, but approximately half of the prevalent oncHPV cases persisted for ≥5 years 9 Persistence is associated with specific risk factors, including prevalent oncHPV, HIV infection, older age, male sex, smoking, taking ART and being on ART for an increased time. 4,5,9 Key predictors of incident oral HPV acquisition included HIV infection, low CD4 cell count, and a high number of oral sex partners. 7,10 HIV heightens susceptibility to oral HPV, hampering clearance, particularly in those with lower CD4+ T-cell counts and individuals aged over 46 years.…”

“…5,11 CD8+ Tcell counts have also gained significance, with higher CD4+/CD8+ ratios (>0.5) negatively impacting overall survival. 5 Better prognosis is linked to ART treatment, undetectable HIV viral load, and high CD4 count. 4,12 As PLWH with HPV-positive OPSCC have improved survival compared to HPV-negative OPSCC, treatment deintensification is sought due to detrimental effects on the immune system and potential drug interactions with ART.…”

“…Those with a nadir CD4+ T-cell count below 200/mm 3 and higher viral load at diagnosis exhibit reduced clearance of high-risk HPVs and had significantly poorer prognosis. 5,11 CD8+ T-cell counts have also gained significance, with higher CD4+/CD8+ ratios (>0.5) negatively impacting overall survival. 5 Better prognosis is linked to ART treatment, undetectable HIV viral load, and high CD4 count.…”

“…[2][3][4] HIV-induced immune activation and chronic inflammation may contribute to carcinogenesis. 5 Immunosuppression, along with higher-risk sexual behaviours, increases the risk for HPV persistence and associated cancers among PLWH. [6][7][8] We present two patients with long-term HIV infection who have been diagnosed with HPV-associated tonsil malignancy.…”

“…2–4 HIV-induced immune activation and chronic inflammation may contribute to carcinogenesis. 5 Immunosuppression, along with higher-risk sexual behaviours, increases the risk for HPV persistence and associated cancers among PLWH. 6–8…”