Sally B. Coburn, PhD, MPH

Among people with HIV (PWH), racial disparities in cancer outcomes have not been fully examined in the context of HIV-specific clinical factors, such as immune status and HIV viral load, according to findings presented at the 2023 Conference on Retroviruses and Opportunistic Infections.

Among PWH diagnosed with cancer in North American from 2000 to 2017, Sally B. Coburn, PhD, MPH, and colleagues estimated 5-year survival and risk factors for 5-year mortality. In their investigation, they included adult PWH participating in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) who were diagnosed with cancer with ICD-O-3 site/histology data. Patients were followed from age of diagnosis to the earliest of one of the following: administrative censoring, lost to follow-up, 5 years of follow-up, or death.

Researchers categorized cancers as virally associated non-AIDS-defining (VAC), AIDS-defining (ADC), or non-AIDS-defining (NADC) cancers. “With age as the timescale, we estimated 5-year survival by cancer type [via] Kaplan-Meier,” the study authors wrote. “We assessed mortality risk factors at cancer diagnosis by cancer type using Cox proportional hazards models including race/ethnicity, viral suppression, CD4 count, AIDS-defining illness (ADI) prior to cancer, and calendar year of cancer diagnosis.”

Age Was an Independent Predictor of Mortality for All Cancers

Among 4,103 patients contributing 12,185 person-years, the study team reported 4,556 cancer diagnoses (827 ADC, 2832 NADC, 897 VAC); 5-year survival was 50.1% for ADCs, 38.5% for NADCs, and 32.9% for VACs. High CD4 count (≥350 cells/mm3) and viral suppression were inversely linked with 5-year mortality. For all cancers, age was an independent predictor of mortality. For ADCs and NADCs, ADI history was correlated with greater risk for mortality. In Black patients, mortality following ADCs and VACs was higher; compared with White patients, mortality for Hispanic patients following NADC was lower.

“Viral suppression and CD4 count were predictive of 5-year mortality following cancer diagnosis across cancer types,” the study authors noted. However, “inconsistent racial mortality disparities by cancer type merit further research.” To thoroughly characterize this link, researchers suggest that future work include screening, stage, cancer treatment, and longitudinal HIV viremia/ immune status.

“Associations with HIV-specific factors and NADCs/VACs underscore the importance of maintaining suppression and high CD4 count following cancer diagnosis and exploring the etiologic role of these factors in cancer progression,” the authors wrote.