20 Years of Being Your Internet HIV/AIDS
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Selected Presentations from CROI 2018
Survival Within 5 Years of Cancer Diagnosis 5 Months Shorter in People With HIV - Cancer Stage, Treatment, and Survival Comparing Hopkins HIV Clinic Enrollees and SEER.
25th Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2018, Boston
Mark Mascolini

Survival in the first 5 years after cancer diagnosis proved 5.4 months shorter in US people with HIV than in a large general-population database [1]. This analysis of the Johns Hopkins HIV cohort also found that HIV-positive people may get diagnosed with cancer at either an earlier stage or a later stage than the general population, a result implying two discrete mechanisms.

Plentiful (not-always-consistent) research suggests that people with HIV differ from the general population in cancer stage at diagnosis, getting appropriate cancer therapy, and survival with cancer. Researchers undertook this study to compare cancer outcomes in members of the Johns Hopkins HIV Clinical Cohort and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER).

The analysis involved 254 newly diagnosed first cancers (excluding Kaposi sarcoma) in the Hopkins cohort from 1997 to 2014 and 1,888,279 first cancers in SEER from 2000 to 2014. The researchers used standard statistical methods to adjust for variables that might affect three primary outcomes: (1) probability of a particular cancer stage at diagnosis (localized, regional, distant, unstaged), (2) probability of receiving any initial cancer treatment, and (3) restricted mean survival time to all-cause mortality 5 years after cancer diagnosis.

Median age at cancer diagnosis in the HIV group stood at 50, two thirds (69%) of people with cancer were men, and 78% were black. The most frequently diagnosed cancers in people with HIV were non-Hodgkin lymphoma (21%), lung cancer (17%), liver cancer (9%), Hodgkin lymphoma (7%), and prostate cancer (7%). Probability of getting treated for cancer did not differ significantly between people with HIV (83%) and the general population (87%), even among people with a low CD4 count.

An analysis adjusted for age, sex, race, diagnosis year, and cancer type determined that people with HIV had a greater chance of getting diagnosed either at a localized stage (probability 0.24, 95% confidence interval [CI] 0.18 to 0.30) or at a distant stage (probability 0.36, 95% CI 0.30 to 0.43).

Another analysis adjusted for the same variables estimated overall survival in the 5 years after cancer diagnosis at 32 months in people with HIV versus 37 months in the general population (difference -5.4, 95% CI -8.2 to -1.4). This survival difference persisted among people with HIV and a CD4 count at or below 200 (difference -6.3, 95% CI -15.7 to -0.4). The difference in 5-year restricted mean survival time for each cancer type remained consistent with the overall survival difference for all cancers.

The Hopkins team proposed that cancer diagnosis at both earlier and later stages in people with HIV suggests two mechanisms: HIV infection may lead to faster cancer progression (leading to diagnosis at a later stage in some). And people in care for HIV may be monitored more regularly than the general population (leading to diagnosis at an earlier stage in others).

1. Calkins K, Chander G, Joshu C, Fojo AT, Moore RD, Lau B. Cancer stage, treatment and survival comparing HIV clinic enrollees and SEER. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 652.