HIV Infected Individuals have Higher Rates of Colon Cancer Related Colon Resection Before Age 50 - Do We Need Earlier Screening?

Abstract

Purpose: Since the advent of highly active anti-retroviral therapy (HAART) in the mid-1990s, the incidence of AIDS and AIDS related mortality has decreased in HIV-infected people. However, the role of disorders that are not classically ‘AIDS related' can be influenced by immune system dysfunction and this needs further study. The aim of our study is to ascertain the age of onset and prevalence of colon cancer among HIV positive individuals vs age and race matched HIV negative controls. We used the prevalence of colectomy among HIV positive individuals as a surrogate for the prevalence of colorectal cancer. Methods: The nationwide inpatient sample for the years 2006-2009 was queried to identify all patient discharges with an underlying diagnosis of colon cancer. All patients with a diagnosis of colitis or a concomitant diagnosis of anal/ rectal cancer were excluded from the current study. The study group consisted of patients with a discharge diagnosis of HIV and control group was HIV negative. The rates of colectomy were then determined for both study and control groups stratified by age and race categories. Univariate analyses were performed using Chi squared tests and survey weighted analysis of variance. Results: There were a total of 353 admissions in the HIV positive group who underwent a colectomy for an indication of colon cancer compared to 319907 in the HIV negative patients. The mean age for colon cancer related colectomy was lower among HIV positive subjects compared to non HIV subjects (56 vs 69 years, p<0.001). Overall, a significant proportion of HIV positive subjects younger than 50 years with colon cancer underwent colectomy compared to the control group 32.6% vs 8.0% (p<0.0001). Among age group 50-65years, there were 47.5% in the HIV positive group vs 27.6% in the HIV negative group. Among > 65 years 19.9% were in the HIV positive group and 64.4% in the HIV negative group underwent therapeutic colectomy for colon cancer (p<0.0001). Among patients younger than 50 years, there were a higher proportion of males, african americans in the HIV positive group compared to control group, (4.3% vs 50.5%, (p=0.04) and 43.4% vs 11.6%, (p<0.001) respectively. Moreover, the mean LOS (10.6 vs 9.6 days) and mean total charges ($71787 vs $ 62211) incurred for HIV positive groupwas higher than those in the control group. Conclusion: HIV positive individuals are at increased risk for earlier onset of colon cancer (< 50 years). This finding suggests that earlier screening of HIV positive patients for colon cancer should be considered.