Background: HIV+ individuals are at increased risk for many cancers, and with an increasing life expectancy due to widespread HAART, this is a growing problem for older adults. Previous studies also suggest that HIV+ individuals may be less likely to receive treatment for cancer. The extent to which rates or specific types of cancer treatment may differ between elderly HIV+ and HIV- individuals is unknown.
Methods: Using SEER-Medicare linked data, we explored differences in cancer treatment by HIV status in Americans aged 66-99 years and diagnosed with non-Hodgkin lymphoma, melanoma, or anal, bladder, breast, colorectal, kidney, liver, lung, or prostate cancer from 1991-2009. HIV+ was identified as the presence of ≥2 Medicare claims with ICD9 diagnosis codes 042, 043, 044 or V08 at least 30 days apart. Medicare claims were searched for cancer-specific surgery, chemotherapy, radiation, hormone/biologic therapy, and/or transplant.
Results: HIV+ cancer cases (n=617) were significantly younger than HIV- cases (n=875,082; median age: 71 vs. 75 years, respectively). Overall, HIV+ cases were less likely to receive cancer-type-specific treatment within 6 months of diagnosis compared to HIV- cases (70% vs. 75%, respectively; p< 0.01) and this difference was even more apparent in individuals ≤70 years (68% treated in HIV+ vs. 82% in HIV-). Median time to treatment was also slightly, but significantly, longer for HIV+ (34 vs. 31 days for HIV-). However, after taking into account differences by gender, race, year, socioeconomic status, comorbidities, and type and stage of cancer, there was no significant effect of HIV on receipt of treatment, regardless of age. Of note, advanced stage at diagnosis had the strongest independent (negative) association with receipt of treatment.
Conclusions: Differences in cancer treatment between HIV+ and HIV- individuals in the elderly American population are likely mediated through difference in personal, medical, or cancer-specific characteristics, which will be explored through advanced analytical techniques. Our findings highlight the complex interplay between age, multiple comorbidities, and cancer-specific differences by HIV, making it clear that a better understanding of factors impacting the cancer care continuum are needed.

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