Individuals living with HIV continue to experience higher incidences of cancer, driven by chronic immune activation, CD4+ T-cell dysfunction, co-infection with oncogenic viruses, and behavioral and social determinants of health. Yet despite evidence demonstrating the safety and efficacy of standard cancer therapies in this population, multiple studies show that people with HIV are less likely to receive cancer treatment compared with HIV-negative individuals. As a result, they frequently present with more advanced or aggressive disease.

Recognizing the complexity at the intersection of HIV and oncology, Baptist Health Miami Cancer Institute has established a dedicated HIV/Cancer Clinic designed to streamline access to specialized care and to advance research in this field. “Miami Cancer Institute and Baptist Health are well-positioned in terms of HIV oncology,” notes hematologist-oncologist Marco Ruiz, M.D., 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.

Now entering its fifth year, the HIV/Cancer Clinic has seen consistent growth. It is a member of the AIDS Malignancy Consortium (AMC), an international organization that researches new treatments and helps provide access to clinical trials. Fewer than 50 institutions worldwide are members, including top cancer organizations such as Memorial Sloan Kettering Cancer Center, MD Anderson Cancer Center, and Johns Hopkins University.

Dr. Ruiz emphasizes the importance of referring patients with HIV-associated hematologic malignancies to centers with dedicated expertise, such as Miami Cancer Institute’s clinic. The National Comprehensive Cancer Network (NCCN) guidelines recommend treating malignancies in individuals with HIV using standard oncologic regimens, with concurrent management by HIV specialists to mitigate drug–drug interactions, overlapping toxicities, and immune-related complications.

“This level of care is unusual,” Dr. Ruiz says. “While some healthcare organizations offer good care for one or the other condition, there are few places that offer the highest-quality care for someone with both diseases.”

Non-Hodgkin lymphoma and Kaposi sarcoma remain the most common HIV-associated malignancies; however, patients with HIV are also at increased risk for lung, anal, prostate, hepatocellular, colorectal, head and neck, breast, and cervical cancers. For now, Miami Cancer Institute’s HIV clinic focuses on hematologic malignancies, with plans for broader expansion.

Miami Cancer Institute’s integrated care model brings together oncologists, infectious disease specialists, transplant physicians, pharmacists, and other clinicians. Treatment planning accounts for antiretroviral therapy (ART) interactions, immune function as it pertains to chemotherapy dosing and tolerance, HIV viral suppression, and monitoring of oncologic progress.

Advances in HIV-associated cancer care are accelerating, Dr. Ruiz says. Novel chemotherapy protocols tailored for immunocompromised populations are emerging, moving beyond the historical practice of excluding these patients from clinical trials. Immunotherapy — once approached with caution — is showing promise, although immune monitoring remains critical.

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 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.

Miami Cancer Institute also has pioneered CAR-T cell therapy for patients with HIV and cancer. Engineering chimeric antigen receptor T cells to target HIV-infected cells is under investigation as a potential curative strategy. The technology is the subject of clinical trials, which Dr. Ruiz says Miami Cancer Institute will participate in. The HIV/Cancer Clinic also is assisting with accrual of patients for other AMC-sponsored studies.

To broaden access throughout South Florida, the clinic is collaborating with Florida International University, leveraging the university’s Miami Adult Studies on HIV (MASH) cohort, a dataset of nearly 1,500 patients accrued over a decade. Dr. Ruiz notes that this partnership will enhance understanding of care-seeking patterns and barriers to treatment for individuals living with HIV in the region.

He encourages physicians caring for patients with HIV to prioritize routine cancer screening and maintain a high index of suspicion for early signs of malignancy. Florida has the third-largest population of people living with HIV nationwide, with nearly 130,000 residents affected — most residing 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.”