Background
People with HIV (PWH) are at increased risk of oropharynx cancer (OPC) compared with people without HIV (PWoH). PWH and OPC also have poorer survival compared to PWoH and OPC. However, prior studies have not evaluated OPC treatment initiation and survival among cohorts of PWH and PWoH matched on demographic variables, stage, and HPV tumor status.
Methods
We conducted a matched retrospective cohort study of PWH and PWoH diagnosed with OPC between 2008-2019 utilizing data from the Veterans Affairs and Kaiser Permanente health systems. PWH and PWoH with OPC were matched 1:1 on sex, age (+ 1 year), race, year of OPC diagnosis (+ 1 year), stage, and HPV status. Patients were followed from OPC diagnosis until death, loss-to-follow-up, or December, 31, 2021. Treatment initiation (chemotherapy, radiation, or surgery) within 180 days, and HPV tumor status were assessed through chart review. Kaplan-Meier curves by HIV and HPV status were conducted. Cox regression was used to assess the association of HIV infection with overall survival adjusting for matching variables, co-morbidity score, alcohol and Tobacco use, and time-dependent chemotherapy and radiation initiation within 180 days of diagnosis.
Results
Our analysis included 130 PWH and 130 PWoH OPC patients. There were no significant differences between PWH and PWoH on matched variables. Overall median age at OPC diagnosis was 57.8 years; 32.3% were non-Hispanic Black, 59% were non-Hispanic White, and 9% were Hispanic. The cohort included 20% diagnosed at stage 1 or 2, and 79.6% were stage 3 or 4a/b; 61.5 % were HPV positive. There was no significant difference in smoking history (82% vs 79% among PWH and PWoH, respectively). PWH and PWoH had comparable rates of chemotherapy and radiation uptake within 180 days (65.2% vs 72%, p= 0.166) and median time to treatment initiation (57 days vs 60 days, p=0.76). PWH had shorter restricted Mean Survival Time to PWoH (3.4 vs 3.9 years, p=0.04); HPV status was the largest predictor of survival regardless of HPV status (figure 1). In adjusted multivariable Cox survival analyses, HIV infection was associated with non-significant increase in mortality (HR 1.48, 95%CI: 1.00 to 2.28, p=0.063).
Conclusions
In a matched cohort of PWH and PWoH with OPC, the two groups had similar treatment rates and timing of treatment initiation. When adjusted for receipt of treatment, When adjusted for receipt of treatment, there was a trend for poorer survival among PWH compared to PWoH.