The Bronx has become the country’s destination for research on HIV-related cancers, thanks to a $111 million National Cancer Institute grant and new leadership position at the AIDS Malignancy Consortium, the only organization worldwide solely dedicated to the study, treatment and prevention of cancer in people with HIV.
Medical oncologist at Montefiore Health System and director for clinical research at Albert Einstein Cancer Center, Dr. Joseph Sparano, principal investigator of the grant, is now leading the consortium and will build on existing research with an eye towards addressing the needs of people with HIV and cancer and caring for marginalized communities.
The Bronx is one of the CDC’s 45 HIV hotspots across the country and has twice as many premature deaths from HIV than in Manhattan. Also, in 2018, there were 27,625 people living in the Bronx with HIV.
The widespread use of antiretroviral therapy to suppress the HIV virus has helped millions of people with HIV live healthier, longer lives, but an unfortunate consequence of people living longer with HIV is an increased risk of cancer. For 25 years, the AIDS Malignancy Consortium (AMC) has led national and international efforts to prevent and treat of HIV-related cancers. Now, Montefiore Health System and Albert Einstein College of Medicine have received a five-year, $111 million grant from the National Cancer Institute (NCI) to lead this research consortium.
“People living with HIV shoulder an enormous burden of cancer,” Sparano said. “AMC is the only organization worldwide solely dedicated to the study, treatment, and prevention of cancer in this group of people. Montefiore and Einstein are perfectly positioned to lead this organization and steer research advances.”
Engaging the Community at Risk
Approximately 38 million people are infected with HIV, including 1.2 million in the U.S. People living with HIV have an increased risk of developing cancer compared with the general population and are more likely to die of cancer, interrupting otherwise healthy lives. This is due to a variety of causes, including long-term inflammation and an overtaxed immune system. In addition, HIV infections are concentrated in marginalized communities in the U.S., primarily among people of color, who make up approximately 70 percent of new infections.
To address this need, Montefiore developed an HIV Oncology Service, directed by Dr. Luca Paoluzzi, a medical oncologist at Montefiore, assistant professor of medicine at Einstein and the AMC PI at Montefiore and Einstein.
Partnership with NIH AIDS Research Center
Collaborating with Dr. Harris Goldstein, associate dean for scientific resources, director of the NIH-funded Einstein-
AMC’s International Network
The AMC oversees a network of 42 clinical trial sites in the United States, Africa and Latin America, as well as translational scientists who support its clinical trials. It also runs a career enhancement program to ensure that the next generation of leaders receive resources and support. In addition, the AMC actively engages with people living with HIV and cancer throughout the world so the consortium can identify and address the needs of this community with their input.
Established in 1995, the AMC has initiated more than 100 clinical trials, surveys, and laboratory studies involving approximately 8,700 individuals. Results from these investigations have strengthened international practice guidelines, including treatment for Kaposi sarcoma and lymphoma, advanced prevention and management of human papillomavirus (HPV)-associated cancers and furthered the use of precision therapeutics and immunotherapy for people living with HIV who receive antiretroviral therapy.
“During this next phase, we will build on these successes, developing and leading additional clinical trials designed to address the most critical needs of people with HIV and cancer, precancerous disease and individuals at high risk for cancer — most importantly, completing the ANCHOR trial,” Sparano said.
The ANCHOR Study
The ANCHOR Study, which stands for Anal Cancer HSIL Outcomes
“Regular screening for anal cancer can catch the disease when it is highly treatable, much like the use of pap smears to identify abnormal tissue before it develops into cervical cancer, which is also caused by HPV,” said Dr. Rebecca Levine, assistant professor of surgery at Einstein, a surgical oncologist at Montefiore and the ANCHOR principal investigator at Einstein and Montefiore. “The aim of the study is to establish best practices for the prevention and treatment of anal cancer. We expect the results of this study will have an enormous impact on clinical care.”
Einstein-Montefiore HIV/AIDS Research and Care
Since HIV emerged in the 1980s, Einstein and Montefiore have been leaders in HIV/AIDS research and clinical care. Its researchers were the first to identify pediatric AIDS as a different disease from adult AIDS and to find effective treatments. Montefiore and Einstein also established one of the first five NIH-supported AIDS Treatment and Evaluation Units and led early studies of HIV among people with substance use disorders. Faculty members are principal investigators on significant NIH-funded initiatives, including the Women’s Interagency HIV Study/Multicenter AIDS Cohort Study and the Central Africa International Epidemiologic Databases to Evaluate AIDS study.
Montefiore’s clinical care programs include the adult AIDS Center, one of the largest HIV treatment programs in the U.S. The AIDS Center’s outpatient Center for Positive Living/Infectious Diseases Clinic offers state-of-the-art care for adults living with HIV/AIDS. Its Oval Center offers sexual health services, testing, care, and counseling along with PrEP and PEP to reduce the risk of HIV infection, and HIV care to LGBTQ+ individuals aged 16 and up. Montefiore’s Adolescent AIDS Program serves 13 to 24-year-olds with comprehensive offerings including mental healthcare and support services, and primary care for LGBTQ+ youth
The grant, titled “AIDS Malignancy Consortium,” was funded by the National Cancer Institute, part of the National Institutes of Health.