Table 1.
Examples of virally associated neoplasms reported in HIV-infected individuals, response to checkpoint blockade and mechanisms of action as well as mechanisms of action
| Cancer | Virus | Immunotherapy | Response Rate (n/total n) (X%) | Common Side Effects |
|---|---|---|---|---|
| Anal Cancer | Human Papilloma Virus | Nivolumab | 1/2; 50% [2] | Anemia, fatigue, rash, hypothyroidism |
| Burkitt’s lymphoma | Epstein Barr Virus | Not reported | Not reported | Not reported |
| Central nervous system lymphoma | Epstein Barr Virus | Not reported | Not reported | Not reported |
| Cervical Cancer | Human Papilloma Virus | Not reported | Not reported | Not reported |
| Hodgkin disease | Epstein Barr Virus | Nivolumab | 1/1; 100% [3] | Not reported |
| Kaposi Sarcoma | Human Herpes Virus-8 | Nivolumab or pembrolizumab | 6/9; 67% [4] | Fatigue, gastrointestinal discomfort, pruritis, onycholysis |
| Kaposi sarcoma-associated herpesvirus multicentric Castleman disease | Human Herpes Virus-8 | Not reported | Not reported | Not reported |
| Merkel Cell Carcinoma | Merkel Cell Polyomavirus | pembrolizumab or avelumab | 2/2; 100% [5, 6] | Pneumonitis |
| Nasopharyngeal Carcinoma | Epstein Barr Virus | Not reported | Not reported | Not reported |
| Penile Cancer | Human Papilloma Virus | Not reported | Not reported | Not reported |
| Plasmablastic lymphoma | Epstein Barr Virus | Not reported | Not reported | Not reported |
| Primary effusion lymphoma | Human Herpes Virus-8 | Not reported | Not reported | Not reported |
| Vulvar Cancer | Human Papilloma Virus | Not reported | Not reported | Not reported |
Biologic mechanisms that are amenable to immune checkpoint blockade associated with cancers in HIV-infected patients
Viral antigens presented by host cells are recognized as foreign [1]
CD4+ T cells in HIV-positive patients have increased expression of the checkpoints CTLA-4 and PD-19,11
The host DNA damage response is impaired in virally-mediated cancers [12]
APOBEC-related mutagenesis is associated with viruses and increases neopeptide hydrophobicity/immunogenicity and correlates with higher levels of PD-L1 expression [7, 8]