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Brickman C, Propert K, Merlin J, Liu J, Eady S, McGhee-Jez A, Ragin C, Grover S, Cohen R, Gross R
Treatment and Outcomes of Oropharyngeal Cancer in Patients with Human Immunodeficiency Virus
AIDS Res Hum Retroviruses (2019) 35:934-940.
INTRODUCTION: 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. METHODS: We conducted a retrospective cohort study comparing OPSCC treatment adequacy and treatment outcomes in HIV-positive and HIV-negative people in the post-antiretroviral 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. RESULTS: 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 (HR 0.61, 95% CI 0.38-0.98). Total post-radiation dose in HIV-positive people was lower than in HIV-negative people (58.5 Gy versus 64.4 Gy, p=0.04). 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. 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.
Publication Date: 2019-10-01.
PMCID: PMC6806360
Last updated on Wednesday, February 05, 2020