Elderly patients with HIV who have cancer, and specifically breast and prostate cancer, may have worse outcomes when compared with elderly patients without HIV with cancer, according to a study published in JAMA Oncology.
Patients infected with HIV have higher mortality rates after cancer diagnosis compared with patients with cancer who do not have HIV. This association remained after adjustment for differences in patient demographics and cancer state. The National Cancer Database indicated that after adjustment for receipt of health insurance and type of facility administering cancer care, patients with HIV who have cancer have elevated mortality rates.
However, previous studies on the appropriateness of cancer treatment in patients with HIV have demonstrated suboptimal rates; outcome differences among these studies may be explained by variation in cancer treatments. To rule out the possibility that variable cancer treatment is the primary driver of the HIV-related survival deficit, adjustments for the type and timing of cancer treatments are needed. However, studies that have described this association have not adjusted in detail for cancer treatment. Therefore, this study compared cancer-specific mortality in patients with cancer who have HIV and those who do not have HIV after adjusting for available data on receipt of specific cancer treatments.
In total, 308,268 patients were identified using Surveillance, Epidemiology, and End Results-Medicare linked data in the United States. Of these, 288 patients had an HIV infection with nonadvanced colorectal, lung, prostate, or breast cancers diagnosed between 1996 and 2012. Included patients also received standard, stage-appropriate cancer treatment during the year after cancer diagnosis. Of these patients, 168,998 were men and 139,270 were women; all were ≥65 years old. Data analysis was performed from 2016 to 2018. The main outcomes were overall mortality, cancer-specific mortality, and relapse or cancer-specific mortality after initial treatment.
After adjustment for patients who were administered first-course cancer treatments, those with HIV had decreased survival rates compared with patients who did not have HIV. When compared with patients without HIV, those with HIV had a significantly increased mortality rate for colorectal cancer (P =.02), prostate cancer (P <.01), and breast cancer (P =.05). Among patients with HIV, cancer-specific mortality was also elevated for breast cancer (P =.07) and prostate cancer (P =.06). Further, individuals with HIV who also had breast cancer or prostate cancer experienced significantly higher rates of relapse or death when compared with patients without HIV (P =.02 and P =.03, respectively).
The results suggested that elevated cancer-specific mortality in patients with HIV may reflect an association between the immunosuppression of the HIV infection itself and cancer control, rather than differences in cancer treatment. Overall, the study authors concluded that, “As the HIV population continues to age, the association of HIV infection with poor breast and prostate cancer outcomes will become increasingly relevant, especially because prostate cancer is projected to become the most common malignant neoplasm in the HIV population in the United States by 2030. Research on clinical strategies to improve outcomes in HIV-infected patients with cancer is warranted.”
Coghill AE, Suneja G, Rositch AF, Shiels MS, Engels EA. HIV infection, cancer treatment regimens, and cancer outcomes among elderly adults in the United States [published online August 1, 2019]. JAMA Oncol. doi:10.1001/jamaoncol.2019.1742