Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
, Mathematica, Ann Arbor, MI, USA.
Cancer Causes Control. 2020 May;31(5):511-516. doi: 10.1007/s10552-020-01289-x. Epub 2020 Mar 6.
A comparison of stage at cancer diagnosis and cancer treatment rates between people with HIV (PWH) and the general US population is needed to identify any disparities by HIV status.
We compared 236 PWH in clinical care diagnosed with cancer from 1997 to 2014 to a sample from NCI's Surveillance, Epidemiology and End Results (SEER) Program, presumed to be HIV negative. We performed G-computation using random forest methods to estimate stage and treatment percent differences (PD) by HIV. We conducted sensitivity analyses among non-AIDS-defining cancers (NADC), by sex and by CD4 ≤ 200 or > 200 cells/mm.
PWH were less likely to be diagnosed at localized stage (PD = - 16%; 95% CI - 21, - 11) and more likely to be diagnosed at regional stage (PD = 14%; 95% CI 8, 19) than those in SEER. Cancer treatment rates were 13% lower among PWH as compared to SEER (95% CI - 18, - 8). The difference in percent receiving cancer treatment was more pronounced for those with lower CD4 at cancer diagnosis (PD -15%; 95% CI - 27, - 6). Lower treatment rates were observed among NADC, males, and women with CD4 ≤ 200.
Cancer care for PWH could be improved by diagnosis at earlier stages and increasing rates of cancer treatment.
需要比较艾滋病毒（HIV）感染者和一般美国人群在癌症诊断时的分期和癌症治疗率，以确定 HIV 感染者的任何差异。
我们比较了 1997 年至 2014 年期间在临床护理中诊断患有癌症的 236 名 HIV 感染者与 NCI 的监测、流行病学和最终结果（SEER）计划中的样本，假设其 HIV 阴性。我们使用随机森林方法进行 G 计算，以估计 HIV 分期和治疗百分比差异（PD）。我们对非艾滋病定义癌症（NADC）、性别以及 CD4≤200 或>200 个细胞/mm 进行了敏感性分析。
与 SEER 相比，HIV 感染者更不可能被诊断为局限性分期（PD=-16%；95%CI-21，-11），更可能被诊断为区域性分期（PD=14%；95%CI 8，19）。与 SEER 相比，HIV 感染者的癌症治疗率低 13%（95%CI-18，-8）。对于癌症诊断时 CD4 较低的患者，接受癌症治疗的比例差异更为明显（PD-15%；95%CI-27，-6）。在 NADC、男性和 CD4≤200 的女性中，治疗率较低。
通过早期诊断和提高癌症治疗率，可以改善 HIV 感染者的癌症护理。
