Disparities in the treatment and outcomes of lung cancer among HIV-infected people in Texas.

aThe Department of Radiation Oncology, The Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA bDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD cTexas Department of State Health Services, Austin, TX.
AIDS (London, England) (Impact Factor: 6.56). 10/2012; 27(3). DOI: 10.1097/QAD.0b013e32835ad56e
Source: PubMed

ABSTRACT OBJECTIVES:: HIV-infected people have elevated risk for lung cancer and higher mortality following cancer diagnosis than HIV-uninfected individuals. It is unclear whether HIV-infected people with lung cancer receive similar cancer treatment as HIV-uninfected people. DESIGN/METHODS:: We studied adults 18+ years old with lung cancer reported to the Texas Cancer Registry (N = 156,930) from 1995-2009. HIV status was determined by linkage with the Texas enhanced HIV/AIDS Reporting System. For non-small cell lung cancer (NSCLC) cases, we identified predictors of cancer treatment using logistic regression. We used Cox regression to evaluate effects of HIV and cancer treatment on mortality. RESULTS:: Compared with HIV-uninfected lung cancer cases (N = 156,593), HIV-infected lung cancer cases (N = 337) were more frequently young, non-Hispanic black, male, and with distant stage disease. HIV-infected NSCLC cases less frequently received cancer treatment than HIV-uninfected cases (60.3% vs. 77.5%; odds ratio 0.39, 95% confidence interval [CI] 0.30-0.52, after adjustment for diagnosis year, age, sex, race, stage, and histologic subtype). HIV infection was associated with higher lung cancer-specific mortality (hazard ratio [HR] 1.34, 95%CI 1.15-1.56, adjusted for demographics and tumor characteristics). Inclusion of cancer treatment in adjusted models slightly attenuated the effect of HIV on lung cancer-specific mortality (HR 1.25; 95%CI 1.06-1.47). Also, there was a suggestion that HIV was more strongly associated with mortality among untreated than among treated cases (adjusted HR 1.32 vs. 1.16, p-interaction = 0.34). CONCLUSION:: HIV-infected NSCLC cases were less frequently treated for lung cancer than HIV-uninfected cases, which may have affected survival.

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