Effective and safe use of immune checkpoint inhibitors for non-small cell lung cancer in people living with HIV.

OBJECTIVES: With the near normalization of life expectancy in people living with HIV through antiretroviral therapy, the management of age-related comorbidities has become increasingly important. Non-AIDS-defining cancers now contribute significantly to both morbidity and mortality in this population, with non-small cell lung cancer (NSCLC) being one of the leading causes of cancer-related deaths among people living with HIV.

METHODS: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of NSCLC in the general population. However, people living with HIV have been largely excluded from pivotal clinical trials, resulting in limited evidence regarding safety and efficacy in this population. This review summarizes the main available literature on ICI therapy in people living with HIV with NSCLC.

RESULTS: The presented data from retrospective analyses and cohort studies suggest that people living with HIV benefit from ICI therapy, with similar response rates and survival outcomes as people living without HIV. The risk of immune-related adverse events in people living with HIV was reported to be comparable to people living without HIV. Importantly, no significant effects of ICI on HIV viral load or CD4 T cell count were reported.

CONCLUSIONS: ICI therapy appears to be both safe and effective in people living with HIV with NSCLC. Optimal management of this patient population requires close interdisciplinary collaboration between oncologists and HIV care specialists. To enhance our understanding, broader inclusion of people living with HIV in clinical trials and the conduct of dedicated HIV-specific studies would be essential.

© 2025 The Author(s). HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.

PMID: 41190419