Abstract B128: Cancer treatment inequities in people with HIV in the United States, 2001-2019

Abstract

Abstract Background: People with HIV (PWH) are at increased risk of both AIDS-defining (i.e., Kaposi sarcoma, non-Hodgkin lymphoma, cervical cancer) and non-AIDS-defining cancers. Prior work with data from 1996-2010 reported that PWH with cancer in the US were less likely to receive cancer treatment. However, an updated analysis is warranted to see if the disparity in receipt of cancer treatment persists for PWH. Methods: We used data from the HIV/AIDS Cancer Match (HACM) Study, a population-based HIV and cancer registry linkage in 13 U.S. states to examine diffuse large B-cell lymphoma (DLBCL), Hodgkin-lymphoma (HL), and cancers of the cervix, lung, anal, prostate, colon, and breast. For each cancer type, we estimated adjusted prevalence odds ratios (aOR) and 95% confidence intervals using logistic regression to assess the relationship between HIV status and cancer treatment adjusted for race, age at cancer diagnosis, sex, cancer stage, year of cancer diagnosis and region. In addition, we used logistic regression to identify predictors of cancer treatment receipt in PWH by cancer site, including race, age at cancer diagnosis, sex, HIV mode of transmission, cancer stage, calendar year period of cancer diagnosis and region. Results: We evaluated 11,657 PWH with cancer and 2,687,946 patients with cancer without HIV. A total of 9,030 PWH with cancer received any cancer treatment (77.5%) compared to 2,218,200 individuals with cancer, without HIV (82.5%) who received any cancer treatment. HIV was associated with lower odds of receiving cancer treatment compared to people with cancer and no HIV for cervical cancer (aOR=0.46 95% CI: 0.35-0.60), DLBCL (0.55, 0.50-0.62), HL (0.64,0.53-0.76), lung cancer (0.57, 0.52-0.62), prostate cancer (0.74, 0.66-0.83), and colon cancer (0.60, 0.50-0.74). Non-Hispanic (NH)-Black PWH with lung cancer were less likely to receive cancer treatment compared to NH-White PWH. People who inject drugs (PWID), PWID/men who have sex with men (MSM) and heterosexual PWH were less likely to be treated for DLBCL, lung cancer and prostate cancer compared to MSM. In contrast, PWID were more likely to receive cancer treatment for anal cancer than MSM. For PWH with DLBCL, those diagnosed in 2011-2014 were 46% more likely to receive treatment (aOR=1.46, 1.00-2.12) compared to those diagnosed in 1996-2000. Conclusion: Inequities in receipt of cancer treatment persist for PWH in the US. We saw for some cancers, PWH had lower odds of receiving cancer treatment, even after controlling for important factors. Beginning in 2018, the National Comprehensive Cancer Network (NCCN) published cancer treatment guidelines explicit for PWH.  Despite improvements in HIV-related treatment, inequitable receipt of cancer treatment will continue to prolong and exacerbate disparities among people with cancer with and without HIV. Citation Format: Jennifer K. McGee-Avila, Gita Suneja, Qianlai Luo, Marie Josephe Horner, Ann Rositch, Eric Engels, Meredith S. Shiels, Jessica Islam. Cancer treatment inequities in people with HIV in the United States, 2001-2019 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B128.