Study: Worse Cancer Outcomes in Older Patients with HIV Not Due to Treatment Differences

Increased cancer-related morbidity among elderly patients with HIV may not be tied to differences in cancer treatment, according to a new study published in JAMA Oncology.

Patients with HIV treated for cancer have worse outcomes compared with those who are HIV-negative. For the study, the researchers aimed to determine whether this elevated cancer-specific mortality in patients with HIV could be explained by variations in cancer treatment.

The study included data from 308,268 patients in the United States aged 65 years and older— including 288 patients with HIV infection—with nonadvanced cancers of the colorectum, lung, prostate, or breast diagnosed between 1996 and 2012 who received standard, stage-appropriate cancer treatment during the year after cancer diagnosis. Using the SEER-Medicare linked database, the researchers were able to adjust for the treatment effect of first-course cancer regimens on patient outcomes.

One year after cancer diagnosis, patients with HIV experienced significant elevations in overall mortality rate compared with patients who did not have HIV for cancers of the colorectum, prostate, and breast. In prostate and breast cancers, patients with HIV also experienced significantly higher rates of relapse or death compared with their HIV-uninfected counterparts. This elevated risk continued to be seen in these patients with HIV who survived at least 15 months after diagnosis, according to the study.

“As the HIV population continues to age, the association of HIV infection with poor breast and prostate cancer outcomes will become more important, especially because prostate cancer is projected to become the most common malignancy in the HIV population by 2020,” Anne E. Coghill, PhD, MPH, assistant member of the Cancer Epidemiology Department at Moffitt Cancer Center, said in a press release. “It is why we are stressing the need for more research on clinical strategies to improve outcomes for HIV-infected cancer patients.”

Even after adjusting for available first-year cancer treatment data, the findings revealed a persistent survival disparity, which indicates that health care differences are not the primary drivers of poor cancer outcomes in the HIV patient population.

The researchers concluded that the findings may indicate an association between immunosuppression and tumor behavior with patient outcomes. They noted that HIV is associated with worse outcomes across a range of cancers with different etiologies, suggesting a broad role for HIV-related immunosuppression in controlling cancer after a tumor has been diagnosed.

“Together, these results suggest that HIV infection itself, likely because of associated immunosuppression, may contribute to elevated mortality in patients with cancer,” the study authors wrote.

References

Coghill AE, Suneja G, Rositch AF, et al. HIV infections, cancer treatment regimens, and cancer outcomes among elderly adults in the United States. JAMA Oncology. 2019. doi:10.1001/jamaoncol.2019.1742

Despite Treatment, Elderly Cancer Patients Have Worse Outcomes if HIV Positive [news release]. Moffitt Cancer Center. https://moffitt.org/newsroom/press-release-archive/2019/despite-treatment-elderly-cancer-patients-have-worse-outcomes-if-hiv-positive/. Accessed August 6, 2019.