In the Journals

HIV infection worsens cancer outcomes among elderly

Anna Coghill
Anna E. Coghill

Elderly patients with HIV and cancer appeared to have worse clinical outcomes than patients without HIV, according to results of a retrospective study published in JAMA Oncology.

This association appeared particularly true for patients with breast and prostate cancers and persisted after adjustment for first-line cancer treatments.

The findings may highlight an association between immunosuppression and cancer control, researchers noted.

“Recent findings from the National Cancer Database have indicated that elevated mortality rates in [patients with HIV and cancer] also remain after adjustment for receipt of health insurance and the type of facility administering cancer care. Together, these results suggest that HIV infection itself, likely because of associated immunosuppression, may contribute to elevated mortality in patients with cancer,” Anna E. Coghill, PhD, MPH, assistant member of the cancer epidemiology program at Moffitt Cancer Center, and colleagues wrote. “However, the possibility that outcome differences are explained by variation in cancer treatment remains, to some extent, unaddressed.”

Coghill and colleagues used the SEER database to identify 308,268 patients (men, n = 168,998) aged 65 years or older diagnosed with nonadvanced cancers of the colorectum, lung, prostate or breast between 1996 and 2012. Among these patients, 288 were infected with HIV.

All patients received standard, stage-appropriate treatment within a year of diagnosis.

Overall mortality, cancer-specific mortality, relapse and cancer-specific mortality after initial treatment served as the study’s main outcomes.

Risk for mortality appeared significantly higher among patients with HIV than those without HIV for colorectal cancer (HR = 1.73; 95% CI, 1.11-2.68), prostate cancer (HR = 1.58; 95% CI, 1.23-2.03) and breast cancer (HR = 1.5; 95% CI, 1.01-2.24).

Cancer-specific mortality rates also were higher, but not significantly so, for patients with HIV and prostate cancer (HR = 1.65; 95% CI, 0.98-2.79) and breast cancer (HR = 1.85; 95% CI, 0.96-3.55) compared with patients without HIV.

Relapse or death appeared significantly more likely among those co-diagnosed with HIV and prostate cancer (HR = 1.32; 95% CI, 1.03-1.71) or breast cancer (HR = 1.63; 95% CI, 1.09-2.43).

A sensitivity analysis that substituted three comorbidities for HIV did not result in higher cancer-specific mortality rates for gastroesophageal reflux (HR = 0.99; 95% CI, 0.96-1.02), essential hypertension (HR = 0.95; 95% CI, 0.93-0.97) or migraines (HR = 0.94; 95% CI, 0.85-1.04).

The SEER-Medicare database includes claims only for adults aged 65 years or older who do not have health maintenance organization coverage, which may limit the study’s generalizability. Also, the data are limited by a lack of information on specific metrics of immunosuppression, such as CD4 T-cell counts.

“As the HIV population in the United States continues to age, the association of HIV infection with poor breast and prostate cancer outcomes will become increasingly relevant, especially because prostate cancer is projected to become the most common malignant neoplasm in the HIV population in the United States by 2030,” Coghill and colleagues wrote. “Research on clinical strategies to improve outcomes in [patients with HIV and cancer] is warranted.” – by John DeRosier

Disclosures: NCI funded this study. The authors report no relevant financial disclosures.

Anna Coghill
Anna E. Coghill

Elderly patients with HIV and cancer appeared to have worse clinical outcomes than patients without HIV, according to results of a retrospective study published in JAMA Oncology.

This association appeared particularly true for patients with breast and prostate cancers and persisted after adjustment for first-line cancer treatments.

The findings may highlight an association between immunosuppression and cancer control, researchers noted.

“Recent findings from the National Cancer Database have indicated that elevated mortality rates in [patients with HIV and cancer] also remain after adjustment for receipt of health insurance and the type of facility administering cancer care. Together, these results suggest that HIV infection itself, likely because of associated immunosuppression, may contribute to elevated mortality in patients with cancer,” Anna E. Coghill, PhD, MPH, assistant member of the cancer epidemiology program at Moffitt Cancer Center, and colleagues wrote. “However, the possibility that outcome differences are explained by variation in cancer treatment remains, to some extent, unaddressed.”

Coghill and colleagues used the SEER database to identify 308,268 patients (men, n = 168,998) aged 65 years or older diagnosed with nonadvanced cancers of the colorectum, lung, prostate or breast between 1996 and 2012. Among these patients, 288 were infected with HIV.

All patients received standard, stage-appropriate treatment within a year of diagnosis.

Overall mortality, cancer-specific mortality, relapse and cancer-specific mortality after initial treatment served as the study’s main outcomes.

Risk for mortality appeared significantly higher among patients with HIV than those without HIV for colorectal cancer (HR = 1.73; 95% CI, 1.11-2.68), prostate cancer (HR = 1.58; 95% CI, 1.23-2.03) and breast cancer (HR = 1.5; 95% CI, 1.01-2.24).

Cancer-specific mortality rates also were higher, but not significantly so, for patients with HIV and prostate cancer (HR = 1.65; 95% CI, 0.98-2.79) and breast cancer (HR = 1.85; 95% CI, 0.96-3.55) compared with patients without HIV.

Relapse or death appeared significantly more likely among those co-diagnosed with HIV and prostate cancer (HR = 1.32; 95% CI, 1.03-1.71) or breast cancer (HR = 1.63; 95% CI, 1.09-2.43).

A sensitivity analysis that substituted three comorbidities for HIV did not result in higher cancer-specific mortality rates for gastroesophageal reflux (HR = 0.99; 95% CI, 0.96-1.02), essential hypertension (HR = 0.95; 95% CI, 0.93-0.97) or migraines (HR = 0.94; 95% CI, 0.85-1.04).

The SEER-Medicare database includes claims only for adults aged 65 years or older who do not have health maintenance organization coverage, which may limit the study’s generalizability. Also, the data are limited by a lack of information on specific metrics of immunosuppression, such as CD4 T-cell counts.

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“As the HIV population in the United States continues to age, the association of HIV infection with poor breast and prostate cancer outcomes will become increasingly relevant, especially because prostate cancer is projected to become the most common malignant neoplasm in the HIV population in the United States by 2030,” Coghill and colleagues wrote. “Research on clinical strategies to improve outcomes in [patients with HIV and cancer] is warranted.” – by John DeRosier

Disclosures: NCI funded this study. The authors report no relevant financial disclosures.