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HIV-Positive Older Adults With Cancer and Worsened Disease Outcomes


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In a study reported in JAMA Oncology, Anna E. Coghill, PhD, MPH, and colleagues found that outcomes are often worse among human immunodeficiency virus (HIV)-positive patients aged 65 years or older with cancer vs HIV-negative patients with cancer, after adjustment for first courses of treatment.

Anna E. Coghill, PhD, MPH

Anna E. Coghill, PhD, MPH

Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data were used to identify 308,268 patients aged 65 years or older (55% male), including 288 with HIV (224 male and 64 female) with nonadvanced colorectal, non–small cell lung cancer (NSCLC), prostate cancer, or breast cancer diagnosed between 1996 and 2012 who received standard, stage-appropriate cancer treatment during the year after diagnosis and survived for at least 1 year after diagnosis.

HIV-positive patients had greater overall mortality rates vs HIV-negative patients among those with colorectal cancer (treatment-adjusted hazard ratio [HR] = 1.73; = .02), prostate cancer (HR = 1.58; < .01), and breast cancer (HR = 1.50; = .05); no significant difference in risk was observed among patients with NSCLC (HR = 1.17, P = .44). Near-significant increases in risk for cancer-specific mortality were observed for prostate cancer (HR = 1.65; = .06) and breast cancer (HR = 1.85; = .07), but not for colorectal cancer (HR = 1.68, P =.12) or NSCLC (HR = 1.04, P = .88). Among patients surviving for 15 months or longer after cancer diagnosis, risk of relapse or death was significantly higher among HIV-positive patients with prostate cancer (HR = 1.32; = .03) and those with breast cancer (HR = 1.63; = .02), but not among those with colorectal cancer or NSCLC.

The investigators concluded, “In the United States, elderly HIV-[positive] patients with cancer, particularly prostate and breast cancers, have worse outcomes than HIV-[negative] patients with cancer. This disparity persists even after adjustment for administered first-course cancer treatments and will become increasingly relevant as the [HIV-positive] population in the United States continues to age.” 

Coghill AE, et al: JAMA Oncol. August 1, 2019 (early release online).

 


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