Coghill Anna E, Suneja Gita, Rositch Anne F, Shiels Meredith S, Engels Eric A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
JAMA Oncol. 2019 Sep 1;5(9):e191742. doi: 10.1001/jamaoncol.2019.1742. Epub 2019 Sep 12.
HIV-infected patients with cancer have an elevated cancer-specific mortality rate compared with HIV-uninfected patients with cancer. However, to our knowledge, studies describing this association have not adjusted in detail for cancer treatment, despite evidence of suboptimal cancer treatment in the setting of HIV.
To compare cancer-specific mortality in HIV-infected and HIV-uninfected patients with cancer after adjusting for available data on receipt of specific cancer treatments.
DESIGN, SETTING, AND PARTICIPANTS: We used Surveillance, Epidemiology, and End Results-Medicare linked data to identify 308 268 patients in the United States (age, ≥65 years), including 288 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. Data analysis was done from August 2016 to September 2018.
HIV infection identified by the presence of Medicare claims.
Overall mortality, cancer-specific mortality, and relapse or cancer-specific mortality after initial treatment.
In this database study of 308 268 patients with nonadvanced cancer (168 998 men and 139 270 women; age, ≥65 years), HIV-infected patients (n = 288) had significant elevations in the overall mortality rate compared with HIV-uninfected patients for cancers of the colorectum (hazard ratio [HR], 1.73; 95% CI, 1.11-2.68; P = .02), prostate (HR, 1.58; 95% CI, 1.23-2.03; P < .01), and breast (HR, 1.50; 95% CI, 1.01-2.24; P = .05). Cancer-specific mortality was elevated for prostate (HR, 1.65; 95% CI, 0.98-2.79; P = .06) and breast cancer (HR, 1.85; 95% CI, 0.96-3.55; P = .07). Compared with their HIV-uninfected counterparts, HIV-infected men with prostate cancer also experienced significantly higher rates of relapse or death (HR, 1.32; 95% CI, 1.03-1.71; P = .03) as did HIV-infected women with breast cancer (HR, 1.63; 95% CI, 1.09-2.43; P = .02).
In the United States, elderly HIV-infected patients with cancer, particularly prostate and breast cancers, have worse outcomes than HIV-uninfected patients with cancer. 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.
与未感染HIV的癌症患者相比，感染HIV的癌症患者癌症特异性死亡率更高。然而，据我们所知，尽管有证据表明在HIV感染情况下癌症治疗效果欠佳，但描述这种关联的研究尚未对癌症治疗进行详细调整。
在对接受特定癌症治疗的可用数据进行调整后，比较感染HIV和未感染HIV的癌症患者的癌症特异性死亡率。
设计、背景和参与者：我们使用监测、流行病学和最终结果-医疗保险关联数据，在美国识别出308268名患者（年龄≥65岁），其中包括288名HIV感染者，他们在1996年至2012年期间被诊断患有非晚期结直肠癌、肺癌、前列腺癌或乳腺癌，并在癌症诊断后的一年内接受了标准的、适合分期的癌症治疗。数据分析于2016年8月至2018年9月进行。
通过医疗保险索赔记录识别出的HIV感染。
总体死亡率、癌症特异性死亡率以及初始治疗后的复发或癌症特异性死亡率。
在这项对308268名非晚期癌症患者（168998名男性和139270名女性；年龄≥65岁）的数据库研究中，与未感染HIV的患者相比，感染HIV的患者（n = 288）在结直肠癌（风险比[HR]，1.73；95%置信区间[CI]，1.11 - 2.68；P = 0.02）、前列腺癌（HR，1.58；95% CI，1.23 - 2.03；P < 0.01）和乳腺癌（HR，1.50；95% CI，1.01 - 2.24；P = 0.05）的总体死亡率显著升高。前列腺癌（HR，1.65；95% CI，0.98 - 2.79；P = 0.06）和乳腺癌（HR，1.85；95% CI，0.96 - 3.55；P = 0.07）的癌症特异性死亡率升高。与未感染HIV的前列腺癌男性患者相比，感染HIV的前列腺癌男性患者复发或死亡的发生率也显著更高（HR，1.32；95% CI，1.03 - 1.71；P = 0.03），感染HIV的乳腺癌女性患者也是如此（HR，1.63；95% CI，1.09 - 2.43；P = 0.02）。
在美国，老年感染HIV的癌症患者，尤其是前列腺癌和乳腺癌患者，其预后比未感染HIV的癌症患者更差。即使在对首次疗程的癌症治疗进行调整后，这种差异仍然存在，并且随着美国HIV感染人群持续老龄化，这一问题将变得越来越重要。
