HIV Impact On US Locoregional Cancer Survival In Older Adults Quantified

medwireNews: HIV infection increases cancer-specific mortality in the elderly, suggests US research, with breast and prostate cancer patients having a particularly high risk compared with HIV-negative counterparts. 

“This disparity persists even after adjustment for administered first-course cancer treatments and will become increasingly relevant as the HIV population in the United States continues to age”, the study authors emphasize in JAMA Oncology.

Anna Coghill, from the H Lee Moffitt Cancer Center & Research Institute in Tampa, Florida, and co-workers, collated information from the Surveillance, Epidemiology, and End Results–Medicare database for 308,268 US patients aged at least 65 years with locoregional colorectal, lung, prostate or breast cancer diagnosed between 1996 and 2012.

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

The data included records for 288 HIV-positive patients: 1 year after cancer diagnosis this group had significantly greater overall mortality than those without HIV for colorectal cancer (hazard ratio [HR]=1.73), prostate cancer (HR=1.58) and breast cancer (HR=1.50).

For cancer-specific mortality, the risk was higher among HIV-infected versus HIV-negative prostate cancer patients (HR=1.65) and breast cancer patients (HR=1.85), with the HR among women with regional-stage breast cancer reaching statistical significance (HR=2.91).

And when the rate of relapse or death was calculated for patients from 15 months after cancer diagnosis, HIV-positive patients with prostate and breast cancer again had a poorer outcome than those without HIV, with significant HRs of 1.32 and 1.63, respectively. 

“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”, write Anna Coghill et al.

“Research on clinical strategies to improve outcomes in HIV-infected patients with cancer is warranted”, they add. 

Reference 

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. JAMA Oncol; Advance online publication 1 August 2019. doi:10.1001/jamaoncol.2019.1742.