Cancer: Treatment Monitoring

• Careful attention must be paid to potential drug-drug interactions between systemic anti-cancer therapy and ART. Advice is available at www.hiv-druginteractions.org
• Chemotherapy and radiotherapy are associated with an unpredictable decline in CD4 counts even in persons stable on ART, OI prophylaxis should therefore be considered at any CD4 count threshold in persons undergoing cancer treatment with chemotherapy and radiotherapy
• Persons affected by KS treated with either liposomal doxorubicin or paclitaxel are not at increased risk of CD4 count decline and standard OI prophylaxis Guidelines should be followed, see Opportunisitic Infections section
• One month after the end of the chemo- or radiotherapy treatment we recommend repeating CD4 counts and following standard OI recommendations, see Opportunisitic Infections section
• Persons undergoing autologous or allogenic stem cell transplantation should follow standard national/local guidance for anti-infective prophylaxis

Specific OI prophylaxis recommended in persons undergoing cancer treatment

• PCP prophylaxis
• Fungal prophylaxis, fluconazole 50 mg qd
  Although the evidence for azole antifungal prophylaxis originates from haematological malignancy in HIV seronegative populations, we recommend use of antifungal prophylaxis in persons with HIV on chemotherapy or radiotherapy especially those affected by haematological malignancies. Fluconazole is the agent of choice because of the favorable interaction profile despite lack of activity against invasive Aspergillosis, see Drug-drug interactions between ARVs and Non-ARVs
• HSV/VZV prophylaxis
• NTM prophylaxis only in those with a detectable plasma HIV-VL