Treatment

The treatment of HIV/AIDS-related cancer depends on the type of cancer, the size and location of the tumor, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for these types of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

It is often difficult to treat cancer in people with AIDS because of the increased risk of infections due to decreased white blood cell count and immune function caused by HIV. However, doctors and researchers are always looking for better ways to treat patients, and recent research has resulted in medical advancements.

Descriptions of the most common treatments for HIV/AIDS-related cancers are listed below, outlined by the specific type of cancer.

Kaposi’s sarcoma

The treatment of HIV/AIDS-related Kaposi’s sarcoma usually cannot cure the cancer, but it can help relieve pain or other symptoms. Doctors will often try to treat the HIV/AIDS itself with antiretroviral treatments; recent advances in the treatment against HIV with highly active antiretroviral treatment (HAART) can effectively control the virus in most patients. This can be followed by palliative care (care given to improve quality of life by treating symptoms and side effects of the cancer or its treatment) for Kaposi’s sarcoma.

Antiviral treatment

Antiviral treatment for HIV/AIDS is effective in reducing the incidence and severity of Kaposi’s sarcoma. Highly active antiviral treatment (HAART) can be effective to treat the tumor and reduce the symptoms associated with Kaposi’s sarcoma for people with HIV/AIDS. It is usually used before other treatments, such as chemotherapy.

Surgery

The goal of surgery is to remove the lesion and the surrounding normal tissue (called a margin). Surgery may be performed by a surgical oncologist, a doctor who specializes in treating cancer using surgery. Surgery is most useful when the lesions are located in a single area or a few specific areas. Two types of surgical procedures are described below.

Curettage and electrodesiccation. In this procedure, the cancer is removed with a curette, a sharp, spoon-shaped instrument. The area can then be treated with electrodesiccation, which uses electric current to control bleeding and kill any remaining cancer cells. Many patients have a flat, pale scar from this procedure.

Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and slough off (shed off). This procedure will sometimes leave a pale scar. More than one freezing may be needed.

Learn more about cancer surgery.

Photodynamic therapy

In photodynamic therapy, a light-sensitive substance is injected into the lesion and stays longer in cancer cells than in normal cells. A laser is directed at the lesion to destroy the cancer cells.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. External-beam radiation therapy may be given as a palliative treatment.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time.

Chemotherapy may help control advanced disease, although curing HIV/AIDS-related Kaposi’s sarcoma with chemotherapy is extremely rare. Usually, for HIV/AIDS-related Kaposi’s sarcoma, chemotherapy is used to help relieve symptoms and to prolong life. Commonly used drugs are liposomal doxorubicin (Doxil, Dox-SL, Evacet, LipoDox), paclitaxel (Taxol), and vinorelebine (Navelbine). Sometimes, chemotherapy is injected directly into the lesion to kill the cancer cells, called intralesional injections.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Immunotherapy

Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function. Some people with HIV/AIDS-related Kaposi’s sarcoma may be treated with alpha-interferon, which appears to work by altering the surface proteins of cancer cells and by slowing their growth. Immunotherapy is generally used in people who are in the good-risk category in the immune system (I) factor of the TIS staging system (see Staging). The most common side effects of alpha-interferon are a decreased white blood cell count and flu-like symptoms.

Non-Hodgkin lymphoma

The two main treatments of HIV/AIDS-related non-Hodgkin lymphoma are chemotherapy and radiation therapy.

Chemotherapy. Chemotherapy is the primary treatment for non-Hodgkin lymphoma. Chemotherapy may be given by mouth or injected into a vein. Previously, chemotherapy treatment for HIV/AIDS-related non-Hodgkin lymphoma was given at lower doses due to the person’s weakened immune system. However, with improving retroviral agents, patients with HIV/AIDS-related non-Hodgkin lymphoma are usually treated with the same doses of drugs given to people with lymphoma who do not have HIV. Rituximab (Rituxan) is a monoclonal antibody (substance made in a laboratory that acts like the antibodies the body naturally produces as part of the immune system's response to fight disease) that is directed against B lymphocytes and is used in combination with chemotherapy for most patients.

Radiation therapy. For people with HIV/AIDS-related lymphoma, radiation therapy may or may not be given along with chemotherapy.

For more information, read about treatment for non-Hodgkin lymphoma.

Cervical cancer

Treatment for women with the precancerous condition called CIN (see Overview) are generally not as effective for women with HIV/AIDS due to a weakened immune system. Often, the standard treatment for HIV/AIDS can reduce the symptoms of CIN.

Women with invasive cervical cancer, and whose HIV/AIDS is well-controlled by medication, are generally treated similarly to women who do not have HIV/AIDS. For more information, read about cervical cancer treatment.

Find out more about common terms used during cancer treatment.