Nevertheless, it took 12–18 months after completing chemotherapy for plasma HIV viraemia to become undetectable in many patients [30]. Importantly, patients with NHL frequently present with CD4 cell counts <200 cells/μL and thus the reduction in CD4 cell count associated with systemic chemotherapy and structured suspension of ART is not ideal. We suggest starting ART in HIV-positive patients with cervical cancer (2C). We recommend starting ART in HIV-positive patients who are commencing radiotherapy or chemotherapy for cervical cancer (1D).

There is less clear evidence to support starting ART in women diagnosed with invasive cervical cancer, despite its status as an AIDS-defining illness. Co-registration studies have PI3K inhibitor shown that ART has not reduced the incidence of cervical cancer [33-35], moreover the effects of ART on pre-invasive cervical dysplasia have been variable with some studies suggesting that ART causes regression of cervical intraepithelial neoplasia [36-42] and others showing no beneficial effect of ART [43-46]. The effects of ART on outcomes in HIV-positive women with invasive cervical cancer have not been reported but analogies with anal cancer may be drawn as the malignancies

R788 share common pathogenesis and treatment modalities. Combined chemoradiotherapy in anal cancer has been shown to cause significant and prolonged CD4 suppression even when ART is administered concomitantly [47-50]. Similarly the toxicity of chemoradiotherapy for HIV-associated anal cancer appears to be less profound among patients

given ART compared to historical controls [48, 49, 51-56]. We suggest starting ART in HIV-positive patients with non-AIDS-defining malignancies (2C). We recommend starting ART in HIV-positive patients who are commencing immunosuppressive radiotherapy or chemotherapy for non-AIDS-defining malignancies (1C). While ART has little effect on the incidence of NADMs [2, 57-64] and there is no evidence that ART alone causes regression of NADMs, the immunosuppressive effects of both chemotherapy [4, 26-28] and radiotherapy [47-50] may justify starting ART in HIV-positive individuals who are commencing systemic anticancer therapy or radiotherapy. Telomerase We recommend that potential pharmacokinetic interactions between ARVs and systemic anticancer therapy are checked before administration (with tools such as: http://www.hiv-druginteractions.org) (GPP). Significant pharmacokinetic and pharmacodynamic interactions have been reported between ARV drugs and systemic anticancer therapies. The mechanisms of the pharmacokinetic interactions include the inhibition and induction by ARV agents of enzymes, especially the CYP450 family and uridine diphosphoglucuronosyl transferase isoenzymes, involved in the catabolism and activation of cytotoxic chemotherapy agents.