My husband has been diagnosed with Stage 3-4 Bladder cancer. So far there is no evidence that the cancer has spread beyond the bladder wall, but he is advised to undergo bladder removal surgery. There are concerns that chemotherapy will complicated HIV treatment. He is on combination therapy with protease inhibitors and anti-virals and has been doing well, with latest tests showing suppression of the virus and CD4 cell counts of almost 300. Few oncologists have had experience with this form of cancer in HIV patients. Are you aware of any expertise in this field? What about various chemotherapies or radiation and HIV treatments?

Given that your husband's virus is suppressed and that his CD4 cell count is about 300, his bladder cancer should be managed exactly as it would be managed were he to be HIV negative. Most of the chemotherapy and radiation treatments do not interfere with the HIV treatments with a few exceptions. One of the HIV drugs AZT (zidovudine, retrovir, combivir, trizivir) does not mix well with chemotherapy. Were your husband to be on any of these forms of AZT, he would be best advised to go on alternative HIV regimen. His HIV doctor should be able to suggest one. The other HIV drug which interferes with chemotherapy is full dose Norvir (ritonavir). It is very usual these days for a patient to be on full dose Norvir. Low dose Norvir, which is more commonly used now-a-days, does not seem to intefere with chemotherapy. One last thing, I typically recommend PCP prophylaxis (e.g. Bactrim) for patients with HIV who are about to undergo chemotherapy, even if the CD4 count is in the 300 range. Your husband should do as well as an HIV-negative bladder cancer patient. The HIV should not make his bladder cancer worse. Good luck.