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Treatment and Outcomes of Oropharyngeal Cancer in People with Human Immunodeficiency Virus.
- Source :
-
AIDS research and human retroviruses [AIDS Res Hum Retroviruses] 2019 Oct; Vol. 35 (10), pp. 934-940. Date of Electronic Publication: 2019 Aug 29. - Publication Year :
- 2019
-
Abstract
- HIV-positive people are at increased risk for malignancies associated with human papillomavirus (HPV) infection, including oropharyngeal squamous cell carcinoma (OPSCC). The purpose of this study was to determine whether cancer treatment disparities exist between HIV-positive and HIV-negative people with OPSCC. We conducted a retrospective cohort study comparing OPSCC treatment adequacy and treatment outcomes in HIV-positive and HIV-negative people in the post-antiretroviral therapy era. Treatment adequacy was determined by measuring two primary endpoints associated with OPSCC survival: time to therapy and total radiation dose. Treatment outcomes were assessed by measuring disease-free and overall survival. We identified a total of 37 HIV-positive and 149 HIV-negative people with OPSCC. HIV-positive people experienced a median delay of 10 days from time of OPSCC diagnosis to start of therapy compared with HIV-negative people [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.38-0.98]. Total post-radiation dose in HIV-positive people was lower than that in HIV-negative people [58.5 Gray (Gy) versus 64.4 Gy, p = .04]. HIV-positive people also experienced greater hazards for disease recurrence (HR 3.43, 95% CI 1.39-8.46) and death (HR 4.21, 95% CI 1.29-13.80) compared with HIV-negative people. In conclusion, we detected a clinically important delay in time to therapy as well as worse disease-free and overall survival in HIV-positive people with OPSCC compared with their HIV-negative counterparts. These findings are relevant to understanding how HIV-positive people are diagnosed and undergo therapy for HPV-associated malignancies and highlight the need to address cancer treatment disparities in this group.
- Subjects :
- Adult
Aged
Anti-HIV Agents therapeutic use
Carcinoma, Squamous Cell epidemiology
Carcinoma, Squamous Cell therapy
Combined Modality Therapy
Comorbidity
Confounding Factors, Epidemiologic
Disease-Free Survival
Female
HIV Infections drug therapy
HIV Seronegativity
HIV Seropositivity
Human papillomavirus 16 isolation & purification
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Recurrence, Local epidemiology
Odds Ratio
Oropharyngeal Neoplasms epidemiology
Oropharyngeal Neoplasms therapy
Papillomavirus Infections epidemiology
Papillomavirus Infections virology
Proportional Hazards Models
Retrospective Studies
Time-to-Treatment
Tobacco Smoking epidemiology
Treatment Outcome
United States epidemiology
Viral Load
Carcinoma, Squamous Cell complications
HIV Infections complications
Oropharyngeal Neoplasms complications
Subjects
Details
- Language :
- English
- ISSN :
- 1931-8405
- Volume :
- 35
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- AIDS research and human retroviruses
- Publication Type :
- Academic Journal
- Accession number :
- 31347379
- Full Text :
- https://doi.org/10.1089/AID.2019.0009