1. HIV and melanoma
Lorenzo Alonso
Reunión GEAM

2. ¿Why to speak about HIV and
melanoma?
• There is a deterioration in the immune system in
HIV patients.
• Immune deficits are associated to an increase in
cancer incidence (transplant recipients)
• Melanoma is a very immunogenic tumor
• Is there an incidence increase of
melanoma in HIV patients?

3. AIDS. 2009 January 28; 23(3): 385–393.
doi:10.1097/QAD.0b013e3283213046.
JNCI 2013; 105: 350-360
Arch Dermatol. 2010;146(6):625-632
A B
C
D
E

4. A, B , C: Merkel cell carcinoma
D.Appendageal carcinoma
C: squamous and basal cell carcinoma

5. Int. J. Cancer: 13, 187–194 (2008)

6. melanoma incidence (registries USA)

7. melanoma incidence: Navarra (Spain)

8. ASSOCIATION HIV/AIDS and melanoma
Situación pRR 95% CI Significado
PreHAART 1,26 1,11-1,43 + 26%
etnicidad
PostHAART
etnicidad
SIDA
1,28
1,26
1,50
1,07
1,1- 1,49
0,97- 1,64
1,12- 2,01
0,83- 1,39
+ 28%
+26%
+50%

9. CLINICAL PRACTICE AND MELANOMA
Clinical Trials exclude HIV patients with melanoma
CTLA-4:
Inverse
correlation with
CD4 levels and
viral load.
Upregulated inn
HIV.
AIDS 2002; 16(4): 519

10. Burke M M et al. JCO 2011;29:e792-e794
©2011 by American Society of Clinical Oncology
“MODEL PATIENT FOR
TREATMENT”
. ECOG 0-1
. Young
. Low viral load
. CD4>500 mm3
. No bulky disease
, Slow clinical agresiveness

11. Conclusions
• 1. There is a relative increase of the incidence
of melanoma(20-50%) in HIV patients.
• 2. Melanoma and HIV a diagnosis challenge:
other cutaneous tumors and special locations
• 3. The uncertainty to treat a patient with
melanoma and HIV is very similar to a patient
without HIV.