Patterns of Cancer Treatment among People with HIV in the Mountain West

Abstract

People with HIV (PWH) are more likely to get cancer than the general population, and cancer is a large and growing cause of morbidity and mortality in PWH. Cancer survival is significantly worse in PWH compared with uninfected people, due in part to lower rates of cancer treatment. There is a lack of high-quality data assessing treatment patterns for cancers diagnosed in PWH in the Mountain West region of the United States, which is underrepresented in HIV malignancy research funding and cancer clinical trial enrollment specific to this population. As such, the current project examined cancer data for two Mountain West states: Utah (UT) and Nevada (NV). In UT, the majority of PWH are treated in the XXX healthcare system, therefore institutional data from 1992 - 2019 was used to identify cases of cancer among PWH in UT. In NV, cancer registry data linked with HIV registry data was anonymized and obtained from 1985 - 2017. Clinical and demographic features, as well as patterns of cancer treatment, are described in both cohorts. We did not pool data or make direct statistical comparisons between the cohorts given the incompatibility of data sources between the two states. Of the 1,089 cases included in the study, 105 were identified in UT and 984 in NV. In both states, most cancer patients with HIV were White (68% UT, 75% NV) and male (78% UT, 86% NV). 23% of patients in Utah were uninsured or had unknown insurance, while 42% of patients in NV were uninsured/unknown. In UT, the most common cancers among PWH were hematologic (22%), gastrointestinal (16%), and genitourinary (13%). In NV, the most common cancers were gastrointestinal (23%), hematologic (20%), and skin (18%). Stage I was more common in UT (44%, 21% NV), while stage IV was more common in NV (35%, 29% UT). Overall, cancer treatment rates for PWH were numerically higher in UT (75%) compared to NV (55%). In UT, 48% of PWH received surgery, 36% received chemotherapy, and 12% received radiotherapy. In NV, 38% had surgery, 43% had chemotherapy, and 15% had radiation. The study identified differences in PWH and cancer diagnosed in UT and NV, although direct statistical comparisons were not made. The number of PWH diagnosed with cancer in NV was higher, cancer stage was more advanced, and treatment rates were lower. These findings reflect higher HIV prevalence, with HIV rates 3x higher in NV vs. UT. Lower utilization of surgery in NV may reflect later stage at diagnosis. Treatment rates in both states were lower than typical for the general population, which may reflect limited access to tertiary medical centers with HIV and oncology specialists for rural patients in the Mountain West. Given lower cancer treatment infrastructure in NV and availability of clinical trials for PWH in UT, community engagement and collaboration between the two states may yield opportunities to improve access to cancer treatment and outcomes for PWH in the Mountain West.