HIV and Co-Infection Management in Integrated Oncology Care in Resource-Constrained Settings

People living with HIV face a substantially elevated risk of both AIDS-defining and non-AIDS-defining malignancies, driven by chronic immune dysregulation, co-infection with oncogenic pathogens — including human papillomavirus (HPV), Epstein-Barr virus (EBV), hepatitis B and C viruses (HBV/HCV), and Kaposi sarcoma-associated herpesvirus (KSHV) — and the long-term effects of antiretroviral therapy (ART). In resource-constrained settings, where HIV prevalence is often highest, patients with concurrent HIV and cancer present distinct pathogenic and therapeutic challenges. Drug–drug interactions between ART and chemotherapeutic or immunotherapeutic agents, altered host immune responses to opportunistic infections during cancer treatment, and unresolved questions about ART initiation timing and CD4-guided clinical decision-making all complicate management. These challenges are sharpened by resource constraints: restricted drug formularies limit anti-infective and ART regimen choices, intermittent supply chains disrupt continuity of therapy, diagnostic capacity for pathogen identification is often limited, and specialist workforce shortages constrain the multidisciplinary decision-making that complex co-management demands.Integrating HIV care into oncology settings offers a model to address these intersecting biological and clinical complexities. Yet the mechanisms underpinning treatment response, host–pathogen dynamics, ART sequencing, and therapy optimisation in this dually diagnosed population remain insufficiently characterised — particularly in low-resource contexts across sub-Saharan Africa, Southeast Asia, South Asia, and Latin America. Key pathophysiological questions remain open: should patients with untreated HIV at cancer diagnosis initiate ART before or concurrent with anticancer therapy? Does a low CD4 count warrant dose reduction, or is it a cancer-driven phenomenon requiring equally aggressive treatment? Can immune reconstitution under ART improve tumour immunology and outcomes?This Research Topic aims to advance understanding of the pathogenesis, host–pathogen interaction, and clinical management of HIV and HIV-associated infections within integrated oncology care models, with a particular focus on resource-constrained settings where therapeutic decision-making is shaped by infrastructural, diagnostic, and pharmacological limitations. We seek contributions that illuminate the biological determinants of disease progression in co-managed patients, evaluate innovative diagnostic and therapeutic approaches feasible in low-resource environments, and report clinical experience with anti-infective and immunotherapeutic regimens delivered alongside cancer treatment.We particularly welcome contributions from researchers working in their own local contexts, including early-career investigators and scientists based in high-HIV-prevalence settings, who bring first-hand clinical and epidemiological insight to the questions at the heart of this collection.To deepen scientific insight into the pathogenesis and therapy of HIV and associated infections in integrated oncology settings, we welcome submissions addressing — but not limited to — the following themes:• Host–pathogen interactions and immunopathogenesis of HIV-associated and oncogenic viral co-infections (HPV, EBV, HBV, HCV, KSHV) in patients undergoing cancer therapy in resource-constrained settings• ART timing, sequencing, and co-administration with anticancer therapy: effects on immune reconstitution, host responses to opportunistic infections, tumour immunology, and treatment outcomes• CD4-guided clinical decision-making in cancer treatment: immune thresholds for treatment initiation or dose modification, the biological basis of treatment aggressiveness decisions, and prognostic value of immune markers in dually diagnosed patients• Drug–drug interactions between ART and chemotherapy or immunotherapy: pharmacokinetics, toxicity profiles, and clinical management strategies• Experimental and clinical investigations of opportunistic infections — viral, bacterial, fungal, and parasitic — in HIV-positive oncology patients, including pathogenesis, host susceptibility, and biological determinants of severity• Clinical, biological, and genetic studies of host susceptibility, risk factors, and prognostic markers for infectious complications in people living with HIV receiving cancer treatment• Tuberculosis and drug-resistant TB (including MDR-TB) in people living with HIV receiving cancer treatment: pathogenesis, clinical impact, treatment interactions with anticancer therapy, and management in resource-constrained settings• Clinical trials and case series of anti-infective agents, immunotherapeutics, and ART regimens delivered alongside oncology treatment, including adaptations for resource-constrained or limited-formulary settings• Diagnostic approaches and clinical management innovations for healthcare-associated and emerging infections in HIV-positive oncology patients, including low-cost or novel diagnostic strategies• Case reports and case series describing unusual presentations, innovative therapeutic approaches, or novel diagnostics for infections in HIV-positive patients receiving cancer treatment Topic editors: Rachel Bender Ignacio, Maganizo Chagomerana Source: https://www.frontiersin.org/research-topics/82478/hiv-and-co-infection-management-in-integrated-oncology-care-in-resource-constrained-settings