December 1 is World AIDS Day. A day meant to raise awareness about HIV and AIDS. The website World AIDS Day is dedicated to HIV-testing and prevalence awareness in the UK. In the United States, you can visit AIDS.gov to learn more.
I have always been interested in HIV and AIDS. I was born in 1986, less than two years after Ryan White was diagnosed with HIV and expelled from school as a result of it. He was treated at a hospital I am very familiar with. (This hospital was the reason I became a nurse after visiting with my friend's little brother at the young age of 6.) I spent much of my older childhood learning about AIDS and trying to understand why it wasn't curable.
Through all of this, I learned about the increased likelihood of certain cancers for AIDS patients. Now, as an oncology/hematology nurse, I am learning more about the risks these patients face and can't help but wonder if our hemophiliac population isn't at a greater risk of all of these issues due to contracting HIV through infusions prior to 1985.
Let's first focus on those with HIV who then get cancer. Most oncology nurses know that Kaposi's sarcoma is an AIDS-specific cancer, but did you know patients with HIV are also at risk for AIDS-related lymphoma (primarily, non-Hodgkin's lymphoma) and primary CNS lymphoma?
HIV patients are considered to have converted to AIDS when they are diagnosed with one of the previously mentioned cancers, as well as if they are diagnosed with cervical cancer.
Because of their decreased immunity, people with HIV are more likely than non-HIV people to contract certain viruses, such as Epstein-Barr virus, human papillomavirus, hepatitis B and C viruses, and human herpes virus. Therefore, it makes sense that those infected with HIV are at greater risk for certain cancers. These individuals are also more likely than the general public to partake in smoking and alcohol consumption, two known "traditional" risk factors for cancer.
My concern with these individuals is that once they are diagnosed with cancer, their decrease in immunity doubles, especially while receiving treatment. I can't help but wonder if these patients are more likely to have longer hospitalizations, poorer outcomes/survival rates, and what we can do to keep them safer.
I would think we should prophylactically place these patients in immunosuppressive precautions, regardless of counts, much as we do for bone marrow transplant patients, once they have reached immunosuppression. They should definitely be in reverse isolation. And they would have multiple "primary" doctors, specifically infectious disease for their AIDS and oncology for their cancer. I think we would have to be diligent with our hand-washing and mask-wearing with these patients and watch for any and every early sign of infection.
Hemophiliacs who contracted HIV due to an infusion, in my opinion, are at even greater risks when the HIV converts to AIDS and they are then diagnosed with a form of cancer. Though I have been unable to find research regarding this specific population, we have to know that while undergoing treatment, they are at an even greater risk of bleeding.
When they receive chemo and their blood counts start to decrease, think about their platelets decreasing. A patient who is already at a higher risk of bleeding due to hemophilia is going to be even more at a greater risk of thrombocytopenia.
As expensive and risky as it is, I would think doctors would want to prophylactically treat these patients with scheduled factor infusions and transfuse platelets at a higher platelet count than they would with a non-hemophiliac thrombocytopenic patient. This would certainly call for even greater interdisciplinary care than usual with our cancer patients, because these patients would have three primary doctors: an infectious disease doctor for the HIV, a hematologist for the hemophilia, and an oncologist for the cancer.
I would love to know if any of you have ever treated patients with AIDS and cancer or hemophilia, AIDS, and cancer. Do you agree with my opinions on this matter? How do you feel these patients should be treated differently or not?
References:
- National Cancer Institute. AIDS-Related Cancers. Available at http://www.cancer.gov/cancertopics/types/AIDS.
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