Innovation in Action: Taking a Dual Approach to Treating Blood Cancer in Patients with HIV

The intersection of HIV and cancer represents one of modern medicine’s most complex challenges, requiring expertise that extends beyond traditional oncology. Baptist Health Miami Cancer Institute has embraced the challenge with a specialized HIV/Cancer Clinic that works to advance research as it provides comprehensive care for patients with human immunodeficiency virus (HIV).

“Miami Cancer Institute and Baptist Health are well-positioned in terms of HIV oncology,” says hematology oncologist Marco Ruiz, M.D., the Institute’s chief of HIV Oncology and HIV Stem Cell Transplantation. “We already have the clinical operations here. We are developing, more and more, the research operations. The future is amazing.”

Miami Cancer Institute’s HIV/Cancer Clinic has grown steadily since it was established five years ago, Dr. Ruiz says. It is a member of the AIDS Malignancy Consortium (AMC), an international organization that researches new treatments and helps provide access to clinical trials and treatments not widely available.

The AMC designation is a reflection of Miami Cancer Institute’s expertise and innovative care, as well as its infrastructure, state-of-the art laboratory capabilities and robust clinical trials program. Fewer than 50 institutions worldwide are members, including top cancer organizations such as Memorial Sloan Kettering Cancer Center.

“This level of care is unusual and not easy to find,” Dr. Ruiz says. “While some healthcare organizations offer good care for one or the other, there are few places that offer the highest-quality care for someone with both diseases.”

Understanding the Need

People living with HIV face higher rates of certain cancers. The reasons are multifaceted; chronic inflammation, immunosuppression, higher rates of co-infections with cancer-causing viruses, and lifestyle factors all contribute.

Studies have found that people living with HIV are treated for cancer at significantly lower rates than HIV-negative people with cancer, even though most treatment courses are safe and effective in this population, Dr. Ruiz says. In many cases, their disease is more advanced and aggressive by the time they seek care.

The most common types of cancer in people living with HIV are non-Hodgkin’s lymphoma and Kaposi sarcoma, two blood cancers. In addition, these patients also experience higher rates of lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, oral/pharyngeal cancer, breast cancer and cervical cancer.

The Specialized Approach

Miami Cancer Institute’s HIV/Cancer Clinic operates on an integrated care model that treats both conditions simultaneously. The approach recognizes that every cancer treatment decision affects HIV management, and vice versa.

The clinic bring together oncologists, infectious disease specialists, clinical pharmacists and other specialists as part of a multidisciplinary team. Treatment planning takes into consideration antiretroviral medication interactions, immune function in chemotherapy dosing, cancer progression and HIV viral load throughout treatment.

Many chemotherapy agents interact with antiretroviral medications, potentially reducing effectiveness of either treatment or increasing toxicity. Specialized pharmacists ensure that treatment regimens work synergistically.

“Many times we need to either reduce the dose or change the antiretroviral therapy once we start chemotherapy or immunotherapy,” Dr. Ruiz says. “We're very fortunate to have experienced infectious disease-oncology pharmacists as part of our team. They play a crucial role.” The availability of more than 20 approved antiretroviral drugs permits the development of tolerable regimens that minimize drug interactions and improve compliance.

Immune function monitoring represents another critical difference. Traditional oncology focuses primarily on tumor response, but HIV cancer clinics must simultaneously track CD4 counts and viral loads. This dual monitoring allows for treatment adjustments before complications arise, also helping to guide when patients can safely undergo aggressive therapies.

Advances in Care

The field of HIV-associated cancer care is advancing rapidly, Dr. Ruiz says. Researchers are developing chemotherapy protocols specifically for HIV-positive populations, moving beyond the historical practice of excluding these patients from clinical trials. New immunotherapy approaches also show promise for treating certain cancers in people with HIV, though careful immune monitoring remains essential.

The HIV/Cancer Clinic at Miami Cancer Institute specializes in bone marrow transplantation, which Dr. Ruiz says has shown great promise for patients with both HIV and cancer. In one of its successful cases, for example, Miami Cancer Institute performed an allogeneic (donor) stem cell transplant on a patient with both HIV and an aggressive form of lymphoma, Dr. Ruiz says. Five years later, the patient has no signs of either disease. “The patient is doing fantastic,” Dr. Ruiz says.

Miami Cancer Institute also has pioneered CAR-T cell therapy for patients with HIV and cancer. Although it is hard for people living with HIV to access it in most treatment settings, this type of immunotherapy uses the body’s T cells (white blood cells that destroy abnormal cells) to find and destroy cancer. The technology is increasingly being investigated as a treatment alternative in clinical trials, which Dr. Ruiz says Miami Cancer Institute will participate in.

Dr. Ruiz says Miami Cancer Institute also is working closely with Florida International University to improve and expand access to potentially life-saving care in South Florida.

“FIU has an amazing database called MASH, for Miami Adult Studies on HIV. This database includes almost 1,500 patients from over the last 10 years,” he says. “It's going to improve not only our understanding of how these patients seek care, but what prevents them from accessing care and what facilitates access.”

Making an Important Impact

Florida has the third highest number of HIV-infected residents in the U.S. According to the Florida Department of Health, there are almost 130,000 individuals with HIV living in the state ― with the largest portion in South Florida.

“Many of these patients need not only clinical interventions, they also need social work, case management, mental health support. It's a different situation for each patient,” Dr. Ruiz says. “This is one of those instances in which a truly multidisciplinary approach is very much needed.”

A specialized clinic for people living with HIV represents more than just medical innovation — it embodies a commitment to serving people who in the past have faced barriers to optimal care. As the program expands at Miami Cancer Institute, it aims to improve outcomes with individualized, compassionate care that recognizes the complexity of each patients’ varied needs.

“There is a huge potential here, especially now in the research arena, with the consortium and the relationship we have developed with FIU,” Dr. Ruiz says.

December 1 is World AIDS Day. To learn more about Miami Cancer Institute’s HIV/Cancer Clinic, click here.