Excess Mortality in Persons with Concurrent HIV and Cancer Diagnoses: A Retrospective Cohort Study.

BACKGROUND

With extended lifespans for people with human immunodeficiency virus (PWH), there is a corresponding increased burden of chronic illnesses, including cancer. Our objective was to estimate the excess mortality among PWH with cancer compared with people without HIV (PWoH), accounting for the higher background mortality in the general PWH population.

METHODS

We identified 39,000 PWH and 387,767 demographically matched PWoH in three integrated healthcare systems from 2000 to 2016. We estimated excess mortality among PWH with cancer, computed as the cancer mortality rate difference-in-difference comparing PWH and PWoH. We evaluated five cancer groups: any cancer; virus-, human papillomavirus-, and Epstein-Barr virus -related cancers; virus-unrelated cancers, and common individual cancers. We fitted a multivariable additive Poisson model to estimate excess mortality among PWH with cancer.

RESULTS

PWH with any cancer had excess mortality compared with PWoH [41.3/1,000 person-years (py), 95% confidence interval (CI), 34.0-48.7]. The highest excess mortality was observed for Epstein-Barr virus-related cancers (63.2/1,000 py, 95% CI, 47.8-78.7), lung cancer (147.7/1,000 py, 95% CI, 41.1-254.3), and non-Hodgkin lymphoma (70.5/1,000 py, 95% CI, 51.4-89.6). Excess mortality among PWH was attenuated from 2009 to 2016, and PWH with cancer had no excess mortality 5 years after diagnosis.

CONCLUSION

PWH in care may have excess mortality from certain cancer types, although disparities may have attenuated over time and do not persist beyond 5 years after diagnosis.

IMPACT

Findings may guide improved clinical practice and suggest further research is needed to investigate whether cancer treatment or other factors contribute to mortality disparities for PWH with cancer.