The exclusion of people living with HIV (PLWH) from clinical trials in lymphoma

Br J Cancer. 2015 Sep 15;113(6):861-3. doi: 10.1038/bjc.2015.301. Epub 2015 Aug 27.

Abstract

Background: The prognosis of non-Hodgkin lymphoma and Hodgkin lymphoma is not affected by HIV serostatus, yet people living with HIV (PLWH) are frequently excluded from clinical trials in lymphoma.

Methods: The UK NIHR Clinical Research Network Study Portfolio website was used to identify all the open clinical trials in lymphoma in the United Kingdom in January 2015. Trials that excluded PLWH were further investigated to evaluate if the exclusion was justified by scientific evidence.

Results: We identified 56 multicentre open clinical trials in lymphoma including 46 interventional trials. People living with HIV were excluded from 32 interventional trials (70%). We identified a biologically valid reason (a potential increased risk of greater immunosuppression) for excluding PLWH from one trial and possibly for one optional arm in another study.

Conclusions: There was no scientific or safety justification for excluding PLWH from most lymphoma clinical trials included on the NIHR portfolio. A clear justification for excluding PLWH was not offered in the available protocols. The exclusion of PLWH should be explicitly justified on scientific grounds in protocols to minimise stigmatisation.

MeSH terms

  • Anti-HIV Agents / pharmacokinetics
  • Anti-HIV Agents / therapeutic use
  • Antibodies, Monoclonal / pharmacokinetics
  • Antibodies, Monoclonal / therapeutic use
  • Antineoplastic Agents / pharmacokinetics
  • Antineoplastic Agents / therapeutic use
  • Clinical Trials as Topic / standards
  • Clinical Trials as Topic / statistics & numerical data*
  • Drug Interactions
  • HIV Infections* / drug therapy
  • HIV Infections* / metabolism
  • Humans
  • Lymphoma / drug therapy*
  • Lymphoma / metabolism
  • Multicenter Studies as Topic / standards
  • Multicenter Studies as Topic / statistics & numerical data*
  • Observational Studies as Topic / statistics & numerical data
  • Patient Selection*
  • Refusal to Treat / statistics & numerical data*
  • United Kingdom

Substances

  • Anti-HIV Agents
  • Antibodies, Monoclonal
  • Antineoplastic Agents