People With HIV Less Likely to Get Treated for Nine Major Cancers

September 2016

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HIV-positive people proved less likely to get treated for nine major cancers -- including lung, breast, and colon cancer -- than people without HIV in a nationwide U.S. study.1 That overall result held true regardless of what kind of health insurance people had and whether they had other illnesses besides cancer.

As people with HIV live longer thanks to antiretroviral therapy, cancer has become a more frequent cause of sickness and death. Among people with HIV, cancer is now the second-leading cause of death, according to results of a large international study.2 In the general population of the United States, cancer is also the second-leading cause of death, after heart disease.3 However, people with HIV and cancer do not live as long as cancer patients without HIV.4,5 And previous research found that people with HIV get treated for cancer less often than people without HIV.6,7 But those previous studies did not consider the possible impact of health insurance and noncancer illnesses on cancer treatment. Because lower treatment rates in people with HIV could contribute to shorter survival in cancer patients with HIV, researchers conducted this nationwide analysis.

How the Study Worked

The study used the National Cancer Data Base to identify people between 18 and 65 years old with cancer diagnosed for the first time from 2003 through 2011. This database includes information on patients from more than 1500 centers across the United States. The researchers focused on the 10 most common cancers in people with HIV: head and neck, upper gastrointestinal (pancreas, stomach, esophagus), colon and rectum, anus, lung, female breast, cervix, prostate, Hodgkin lymphoma, and diffuse large B-cell lymphoma (the most frequent non-Hodgkin lymphoma in people with HIV).

The research team used the database to determine (1) who had HIV infection, (2) which noncancer illnesses study participants had, and (3) which patients received cancer therapy (which could include surgery, radiotherapy, chemotherapy, or any combination of these therapies). The investigators used an accepted statistical method to determine the impact of HIV infection on lack of cancer treatment. This type of analysis determines the impact of HIV regardless of whatever other factors might affect lack of cancer treatment, including insurance status and other noncancer illnesses. (Other illnesses may make cancer therapy too risky to perform.) The researchers used a similar type of analysis to pinpoint factors that predicted lack of cancer treatment in people with HIV.


What the Study Found

The study involved 10,265 people with HIV and 2,219,232 without HIV. Compared with the HIV-negative group, people with HIV were younger (median age 47 versus 55 years) and more often men (77% versus 47.6%), black (41.1% versus 13.2%), Hispanic (14% versus 5.7%), using Medicaid (32.2% versus 10.1%), using Medicare (19.6% versus 8.4%), and without health insurance (10.3% versus 5.9%). Almost three quarters of the HIV-negative group (72.5%) had private health insurance, compared with only one third (35.5%) of the HIV group. A higher proportion of people with HIV than without HIV had at least one noncancer illness (23.5% versus 17.9%). HIV-positive people were more likely to have stage 4 (advanced) cancer (37.2% versus 18.9%), and people without HIV were more likely to have stage 1 or 2 cancer (57.2% versus 33.2%).

Chances of not getting treated for anal cancer were similar in people with and without HIV infection. But for the other nine cancers, HIV-positive people had a higher chance of not getting treated (Figure 1). This analysis found a higher chance of nontreatment with HIV regardless of several other nontreatment risk factors, including age, sex, race, insurance status, noncancer illnesses, year of cancer diagnosis, and cancer stage. In an analysis that included only stage 2 to 4 prostate cancer (eliminating the least advanced stage 1, which often requires no treatment), people with HIV had almost a doubled chance of not receiving treatment compared with HIV-negative people.

Higher Chance of No Cancer Treatment With HIV

Higher Chance of No Cancer Treatment With HIV
Higher Chance of No Cancer Treatment With HIV

Figure 1. Compared with HIV-negative cancer patients, people with HIV and cancer had a higher chance of not getting treated for nine cancers: (A) Head and neck, upper gastrointestinal (GI), colon and rectum, lung, breast, and (B) cervix, prostate, Hodgkin lymphoma, and large B-cell lymphoma (a non-Hodgkin lymphoma). (Credit: Teresa B. Southwell)

Next the researchers focused only on HIV-positive and HIV-negative people who had private health insurance. Despite having private health insurance, people with HIV infection still had a higher chance of not getting treated for seven cancers than did HIV-negative people with insurance: upper gastrointestinal, colon and rectum, lung, breast, prostate, Hodgkin lymphoma, and B-cell lymphoma (Figure 2). As in the overall analysis, HIV-positive people ran a higher chance of not getting treated regardless of other nontreatment risk factors.

Higher Chance of No Cancer Treatment With vs Without HIV in People With Private Insurance

Higher Chance of No Cancer Treatment With vs Without HIV in People With Private Insurance

Figure 2. Among HIV-positive and HIV-negative cancer patients with private health insurance, those with HIV had a higher chance of not getting treated for the seven types of cancer listed here. GI, gastrointestinal. (Credit: Teresa B. Southwell)

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A Closer Look at Cancer Among People Living With HIV
Taking a Closer Look at Cancer Treatment Rates Among Elderly Adults Living With HIV
Lower Chemotherapy Rates for HIV-Positive Hodgkin May Explain Worse Survival

This article was provided by The Center for AIDS Information & Advocacy. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.

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