Publication Abstract

Authors: Rositch AF, Jiang S, Coghill AE, Suneja G, Engels EA

Title: Disparities and determinants of cancer treatment in elderly Americans living with HIV/AIDS.

Journal: Clin Infect Dis :-

Date: 2018 Apr 27

Abstract: Background: Previous studies suggest that HIV-infected cancer patients are less likely to receive cancer treatment.The extent to which this disparity affects the growing population of elderly individuals is unknown and factors that mediate these treatment differences have not been explored. Methods: We studied 930,359 Americans aged 66-99 years old who were diagnosed with 10 common cancers. SEER-Medicare claims from 1991-2011 were used to determine HIV status and receipt of cancer treatment in 6 months following diagnosis. Mediation analysis was conducted to estimate the direct effect of HIV, and indirect effect of cancer stage at diagnosis and comorbidities, on cancer treatment. Results: HIV-infected individuals (n=687) were less likely to receive cancer treatment (70% vs. 75% HIV-uninfected; p< 0·01). This difference was larger in individuals ≤70 years, among whom only 65% were treated (vs. 81% HIV-uninfected; p< 0·01), and time from cancer diagnosis to treatment was longer (median 42·5 vs. 36 days HIV-uninfected; p<0·01). Accounting for potential confounders, HIV-infected individuals aged ≤70 remained 20% less likely to receive cancer treatment (hazard ratio=0·81; 95% confidence interval=0·71, 0·92). Seventy-five percent of this total effect was due to HIV itself, with a nonsignificant 25% mediated by cancer stage and comorbidities. Conclusions: The lowest cancer treatment rates were seen in the younger subset of HIV-infected individuals, who would likely benefit most from treatment in terms of life expectancy. To develop effective interventions, it is imperative to identify factors that mediate the relationship between HIV and low cancer treatment rates.