Objectives
  • To define the natural history and spectrum of acquired immunodeficiency syndrome (AIDS)-defining neoplasms in the setting of underlying human immunodeficiency virus (HIV) infection and associated risk behaviours

  • To define the natural history and spectrum of non-AIDS-defining neoplasms and associated risk behaviours in patients with HIV/AIDS

  • To understand the various underlying tumourigenic viral pathogens, disease associations and pathogenesis

  • To extrapolate treatment approaches with appropriate knowledge of tumour stage and clinical and immune status of the patient

  • To become conversant in anticancer systemic and palliative therapeutics and underlying combination antiretroviral therapy (cART) and prophylaxis of opportunistic infections (OIs)

Awareness
  • Familiarity with the different tumour types (AIDS- and non-AIDS-defining) commonly seen in the backdrop of HIV infection

  • Awareness of the importance of reliance on clinical skills of thorough history taking, physical examination and identification of signs and symptoms unique to patients with underlying immune deficiency

  • Awareness of strengths and weaknesses of available diagnostic and staging capabilities

  • Awareness of strengths and weaknesses of available pathological capacity—fine needle aspiration (FNA) versus core needle biopsy, histology, immunohistochemistry (IHC), molecular diagnostic profiling and tumour tissue interrogation

  • Awareness of strengths and weaknesses of available laboratory capabilities to fully define stage of HIV infection, viral replication, resistance patterns and immune status

  • Awareness of strengths and weaknesses of available therapeutic modalities (ie, surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, and cART and OI prophylaxis)

  • Awareness of strengths and weaknesses of available palliative care interventions, pain management, symptom management, and supportive and hospice referral capabilities

  • Awareness and resourcefulness of many complementary medical assessments such as tumour mapping, physical examination diagrams and measurements, simple photography of skin lesions and characterisation of other physical findings

Knowledge
  • Knowledge sets composed of basic understanding of epidemiology, pertinent disease pathogenesis, natural history, clinical manifestations and general orientation to therapeutic and/or preventive approach of the different AIDS-defining tumour types—Kaposi's sarcoma (KS); non-Hodgkin's lymphoma (NHL), including primary central nervous system lymphoma (PCNSL) and Burkitt lymphoma (BL); cervical cancer; squamous cell carcinoma of oral cavity (OSCC)

  • Knowledge sets of the different non-AIDS-defining tumour types, especially Hodgkin's lymphoma (HL), anal cancer, lung cancer in certain settings and hepatocellular cancer

  • Understanding and knowledge of disease pathogenesis by virtue of coinfection with other tumourigenic viruses (eg, Kaposi's sarcoma-associated herpes virus (KSHV), Epstein-Barr virus (EBV), human papilloma virus (HPV) and hepatitis-B virus (HBV)) in the backdrop of HIV infection

  • Familiarity with differences in clinicopathological and molecular characterisation, disease patterns and natural history of KS (eg, classical vs endemic vs epidemic vs transplant less important) and NHL (eg, HIV-associated and non-HIV associated)

  • Knowledge of the thoughtful clinical assessment of tumour stage and immune status in selecting and optimising therapeutic approaches to the HIV-infected patient with cancer

  • Knowledge base in cART, monitoring of viral replication and immune status

  • Familiarity with suitable therapeutic approaches employing all modalities of cancer therapy for all tumour types

  • Knowledge of supportive and palliative care interventions, including pain management and hospice referral and usage

  • Familiarity with suitable prevention strategies, including modifying risk behaviours

  • Familiarity with systems-based knowledge and with multidisciplinary team approaches in the management of patients with AIDS-associated malignancies

  • Understanding of cART treatment, drugs, monitoring and OI prophylaxis strategies

  • Knowledge of systemic chemotherapy agents

  • Understanding of the safety profiles of cART and systemic chemotherapy and the management thereof

  • Familiarity with the identification of the access to new strategies of care for HIV infection and cancer through access to clinical trials and other appropriate supportive interventions that may be available

Skills
  • Ability to contribute actively to a variety of settings (outpatient clinics, inpatient wards, multidisciplinary tumour boards, women's health clinics and HIV clinics) to gain access to the spectrum of cases of malignant disease encountered in the backdrop of HIV infection

  • Ability to perform a thorough history and physical examination, including nuanced history and sentinel physical examination findings indicative of HIV risk behaviours and/or stigmata of HIV disease

  • Ability to contribute actively in the presentation and discussion of cases

  • Ability to contribute actively in the clinical decision-making of cases along the continuum of care from prevention and counselling to diagnostic, therapeutic (HIV therapy and anticancer therapy across all modalities), and palliative care and end-of-life decision-making

  • Ability to guide clinical recommendations across the continuum of care based on understanding of performance status, tumour stage, clinical status and comorbid conditions, and immune status

  • Ability to participate in multidisciplinary team approaches to the management of patients with AIDS-associated malignancies