Among Elderly Patients With Cancer, Those With HIV Fare Worse Even After Adjusting for Treatment Variation

People living with HIV who are diagnosed with cancer have increased mortality rates compared with patients diagnosed with cancer who are not HIV positive. Previous research has shown that survival disparities persist even when adjusting for differences in patient demographics, cancer stage, health insurance, and site of care.

Adding to the evidence, a study published today in JAMA Oncology found that higher cancer mortality rates among people living with HIV remain even after adjusting for variations in cancer treatment, especially in breast and prostate cancers. The findings, combined with previous research, suggest that HIV infection itself may be a driver of higher cancer mortality rates, likely because of the associated immunosuppression.

Collecting data on 288 patients with HIV diagnosed with cancer and more than 300,000 patients diagnosed with cancer who were not infected with HIV, all of whom were 65 years or older, the researchers found that patients with HIV were 1.85 times more likely to die of breast cancer and 1.65 times more likely to die of prostate cancer.

“The association between HIV and elevated cancer-specific mortality was statistically significant for women diagnosed with regional-stage breast cancer, with HIV-infected women being nearly 3 times more likely than HIV-uninfected women to die,” wrote the researchers.

Patients diagnosed with colorectal, lung, prostate, or breast cancer between 1996 and 2012 were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. All patients received stage-appropriate treatment during the year following diagnosis, and the researchers further adjusted to address potential residual confounding. Adjustment was based on common regimens used in the study population.

“Our use of the SEER-Medicare linked database allowed us to adjust for the treatment of first-course cancer regimens on patient outcomes,” wrote the researchers. “This approach is important given the lower cancer treatment rates often observed in the HIV-infected patient population with cancer.”

Rates of overall mortality were also higher among patients with HIV for colorectal cancer (hazard ratio [HR], 1.73), prostate cancer (HR, 1.58), and breast cancer (HR, 1.50).

For patients who survived at least 15 months from diagnosis, the researchers looked at the risk of relapse or cancer-specific death and showed that men with prostate cancer who were HIV positive were 1.28 times more likely to experience either outcome. Women with breast cancer who had HIV were nearly twice as likely (HR, 1.90) to experience relapse or cancer-specific death.

Reference

Coghill A, Suneja G, Rositch A, Shiels M, Engels E. HIV infection, cancer treatment regiments, and cancer outcomes among elderly adults in the United States [published online August 1, 2019]. JAMA Oncol. doi: 10.1001/jamaoncol.2019.1742.