Differences in real-world liver cancer treatment patterns among people living with HIV/AIDS (PLWHA) compared to those without HIV/AIDS (PWoHA).

Abstract

e19010 Background: Antiretroviral therapy (ART) has brought life expectancy among PLWHA on par with PWoHA, but the disparity in cancer incidence and mortality among PLWHA remains high. Hepatocellular carcinoma (HCC) is 4 times more common in PLWHA and an important cause of mortality. Guidelines now support treatment and management of cancer among PLWHA to follow those for PWoHA, but PLWHA have been excluded from registrational trials of novel agents. This study aimed to assess real-word differences in demographics and systemic therapy patterns for HCC among PLWHA and PWoHA. Methods: Adult patients with ≥2 claims for HCC between 1/1/13-12/31/18 (earliest claim = index date), ≥3 months data pre/post index date, and no evidence of clinical trial participation, pregnancy or other malignancy prior to index date were identified from Symphony Health longitudinal prescription and medical claims. Patient characteristics and treatment patterns were summarized by descriptive statistics, and comparisons across HIV status were made on univariate analyses. Times to discontinuation were estimated by Kaplan-Meier method and compared by log-rank tests. Results: There were 9,904 HCC PWoHA who received systemic therapy. Of 862 PLWHA with HCC, 162 (19%) received systemic therapy. PLWHA differed significantly from PwoHA: median age at diagnosis (60 v 63 years), male preponderance (84% v 71%), geography (Northeast, 41% v 19%; West, 22% v 45%), Charlson Comorbidity Score (median 7 v 1), depression (11% v 6%), chronic pulmonary disease (20% v 12%), liver disease (66% v 52%) and kidney disease (17% v 7%, all P< 0.05), respectively. First line (1L) therapy differed among PLWHA and PWoHA: sorafenib (34% v 25%), everolimus (1% v 4%), and doxorubicin-based regimens (42% v 33%; all P< 0.05). IOs were used in 1L and 2L among 584 (6%) and 223 (15%) of PWoHA and among 8 (5%) and 6 (19%) PLWHA, respectively (all P> 0.05). Median times from 1L start to 2L were numerically shorter among PLWHA and PWoHA (4.7 v 5.5 months; P= 0.77). The minority of patients among PLWHA and PWoHA continued onto 2L (20% and 15%, P> 0.05) and 3L (7% and 3%, P< 0.01), respectively. Conclusions: HCC is diagnosed at younger age among PLWHA v PWoHA. Important differences in comorbid disease burden in addition to HIV can impact clinical decision making in PLWHA. Future real-world research is needed to understand disparities in outcomes of PLWHA and develop guidelines specific to this group.