Women With HIV on Medicaid Have Higher Prevalence of Cervical, Anal Cancers

Among women who are on Medicaid, women living with HIV have a much higher prevalence of cervical and anal cancers—which are both related to human papillomavirus (HPV)—compared with women without HIV.

Specifically, women with HIV had a cervical cancer prevalence 4.2 times higher, and an anal cancer prevalence 19.3 times higher, compared with those without HIV. These women were also much more likely to develop Kaposi sarcoma and non-Hodgkin lymphoma.

These findings were published in Women’s Health.

“Older age is also associated with increased burden of non-AIDS-defining cancers in women living with HIV,” the authors said. “Our findings emphasize the need for not only cancer screening among women living with HIV but also for efforts to increase human papillomavirus vaccination among all eligible individuals.”

The authors used diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification to identify 72,508 women living with HIV and 17,353,963 women without HIV covered by Medicaid, flagging for 15 types of cancer and differentiating between AIDS-defining and non-AIDS-defining cancers.

The study revealed higher adjusted prevalence ratios (APRs) for specific cancers among women with HIV. Kaposi sarcoma, a cancer commonly associated with HIV, exhibited the highest APR of 81.79 (95% CI, 57.11-117.22). The authors called this stark difference “a notable but unsurprising finding.”

Non-Hodgkin lymphoma followed with an APR of 27.69 (95% CI, 21.67-35.39).

Additionally, HPV-associated cancers such as anal and cervical cancer demonstrated APRs of 19.31 (95% CI, 17.33-21.51) and 4.20 (95% CI, 3.90-4.52), respectively.

The study also examined age-related differences among women living with HIV. In this group, the APR for all types of cancer combined was nearly twice as high at 1.99 (95% CI, 1.86–2.14) in women aged 45-64 years compared with women aged 18-44 years. The APRs for non-AIDS-defining cancers were higher in older women, while no significant differences were found for AIDS-defining cancers.

While there were no significant differences for all combined cancer types in the race and ethnicity-stratified analyses of women living with HIV, there were differences between Hispanic and non-Hispanic women in cancer type-specific sub-analyses.

Notably, Hispanic women had an APR of 2.00 (1.30-3.07) for non-Hodgkin lymphoma, and 0.73 (0.58-0.92) for breast cancer.

“Given that additional risk factors (e.g. smoking and non-HPV co-infections) increase cancer risk in PLWH, our findings highlight the importance of cancer risk evaluation and screening,” the authors said. “Preventive measures should address multiple risk factors, and promote HPV vaccination in all eligible individuals.”

The study has several limitations regarding the use of Medicaid data for demographic variables, the absence of reliable measures for behavioral risk factors, and the incomplete consideration of co-infections with oncogenic viruses. The data from 2012 may not fully represent the dynamic Medicaid population, and these findings may not be applicable to the broader population of women with HIV. Additionally, this study sample only included women with diagnosed HIV, highlighting the need for ongoing monitoring of cancer burden in Medicaid-insured women with HIV.

Reference

Zhou G, Koroukian SM, Navale SM, et al. Cancer burden in women with HIV on Medicaid: A nationwide analysis. Womens Health (Lond). 2023;19:17455057231170061. doi:10.1177/17455057231170061