Globally, India has one of the largest populations of HIV-infected people, estimated at 2.40 million individuals. Malignancy is a known co-morbidity of HIV infection and is growing in proportion in many parts of the world. The incidence and manifestations of cancer in HIV-infected individuals in India has not yet been well characterized, and the proportion of patients with undiagnosed HIV infection who may be presenting with cancer as their first manifestation of HIV infection is not known. The goal of this proposal is to obtain information on the prevalence of HIV in the cancer population seen over a 1-2 year period at a major cancer treatment and referral center in Northern India. We will similarly assess the HIV prevalence of patients presenting to cancer screening clinics at the same institution (e.g. breast, cervical and prostate). Another goal is to collect information;demographics, HIV and clinical status at presentation, HIV and cancer risk factors, as well as information on incidence of cancer, cancer types, stage, treatments and treatment outcomes in patients with HIV and cancer. In addition we will similarly assess various cancer risk factors and the prevalence of various oncogenic viruses in patients with incident cancers (compared to concurrent control HIV+ individuals from the same HIV clinic at the same institution that do not develop cancer in the timeframe of this study. This will allow assessment of HIV prevalence in various cancers types as well as provide information on the short- term cancer incident and various risk factors and co-factors for cancer development among HIV-infected persons. Identified cancer and HIV individuals from this study will be enrolled in a cancer and HIV registry and specimen/tissue bank, which we will help establish, for prospective follow-up and specimen collection to obtain data on cancer and HIV treatments and clinical outcomes and to provide a cohort for future research studies, including epidemiologic, laboratory and possible clinical trial. Establishment of the HIV and cancer registry with collected tumor and blood specimens will provide our Indian investigator colleagues with a valuable resource for further research (with additional future Indian outside funding). This study will involve a collaboration between investigators at UCLA, the All India Institute for Medical Sciences (AIIMS) in New Delhi and the Dr. B.R. Ambedkar Institute and Rotary Cancer Hospital (DR BRAIRCH) at AIIMS The overall goal is to better characterize the important association of HIV and cancer in India and to identify risk factors and potential viral co-factors which may ultimately service as the basis for future therapeutic and prevention interventions for this important co-morbidity in HIV.
Determining the prevalence of undiagnosed HIV infection in individuals with cancer presenting to a regional cancer hospital will help the Indian Ministry of Health and the National AIDS Control Organization to understand the linkage of HIV and cancer and allow earlier diagnosis of HIV in this population, thus allowing earlier HIV treatment and increasing the awareness of the greater risks of complications during cancer treatment. Understanding the risk factors and association of various risk factors and oncogenic viruses with cancer development in the HIV population may also help inform future cancer prevention trials in HIV, where cancer related morbidity and mortality is increasing rapidly. Finally establishing an HIV and cancer registry and specimen repository will allow for continued monitoring of cancer and HIV outcomes in this co-morbid population, provide an important resource for future research, and may result in changes in patient management to improve therapeutic outcomes