Are HIV-Infected Men Vulnerable to Prostate Cancer Treatment Disparities?

Abstract

Background HIV-infected (HIV+) men face cancer treatment disparities which impact outcome. Prostate cancer (PCa) treatment and treatment appropriateness in HIV+ men are unknown. Methods We used electronic chart review to conduct a retrospective cohort study of 43 HIV+ cases with PCa and 86 age- and race-matched HIV-uninfected (HIV−) controls with PCa, aged 40–79, from 2001–2012. We defined treatment appropriateness using National Comprehensive Cancer Network (NCCN) guidelines and the Charlson Co-morbidity Index (CCI) to estimate life expectancy. Results Median age was 59.5 years at PCa diagnosis. Median CD4+ T-cell count was 459.5cells/mm3, 95.3% received antiretroviral therapy, and 87.1% were virally suppressed. Radical prostatectomy (RP) was the primary treatment for 39.5% of HIV+ and 71.0% of HIV− men (p= 0.004). Only 16.3% of HIV+ vs. 57.0% of HIV− men received open RP (p< 0.001). HIV+ men received more radiotherapy (25.6% vs. 16.3%, p= 0.13). HIV was negatively associated with open RP (OR= 0.03, p= 0.007), adjusting for insurance and CCI. No men were undertreated. Fewer HIV+ men received appropriate treatment (89.2% vs. 100%, p= 0.003), due to 4 overtreated HIV+ men. Excluding AIDS from the CCI still resulted in fewer HIV+ men receiving appropriate treatment (94.6% vs. 100%, p = 0.03). Conclusion PCa in HIV+ men is largely appropriately treated. Under-or overtreatment may occur from difficulties in life expectancy estimation. HIV+ men may receive more radiotherapy and fewer RPs, specifically open RPs. Impact Research on HIV/AIDS survival indices and etiologies and outcomes of this PCa treatment disparity in HIV+ men is needed.

Cancer survival in people with AIDS: A population‐based study from São Paulo, Brazil

“…Wide gaps in survival according to AIDS status were seen for tumors which are not particularly aggressive in the general population, namely bladder cancer (HR = 8.11), prostate cancer (HR = 6.07) and NMSC (HR = 5.39). Prostate cancer does not seem to have more severe presentation in HIV‐infected people, but Riedel et al . observed advanced disease more frequently in this population .…”

Racial differences in prostate cancer risk in young HIV-positive and HIV-negative men: a prospective cohort study

“…Prostate cancer diagnosis and management are becoming increasingly important issues for aging populations with HIV infection (27). Overdiagnosis, overtreatment, and compromised quality of life are potential disadvantages of population-wide PSA screenings (24).…”

“…African American men are also at higher risk for more aggressive tumors, and higher prostate cancer-related mortality. Management of prostate cancer risk and outcomes in African American men is influenced by racial disparities in health care access, surveillance, treatment, and survival (5, 6, 8, 26, 27). African American men are disproportionately represented among HIV-infected men, a population more vulnerable to health care disparities in comparison to uninfected men (5, 27, 28).…”

“…Management of prostate cancer risk and outcomes in African American men is influenced by racial disparities in health care access, surveillance, treatment, and survival (5, 6, 8, 26, 27). African American men are disproportionately represented among HIV-infected men, a population more vulnerable to health care disparities in comparison to uninfected men (5, 27, 28). A recent study in the HAART era found that HIV-infected men were largely appropriately treated in comparison to HIV-uninfected men, though under- or over-treatment sometimes occurred due to difficulty estimating life expectancy (27); disparities by HIV status remained for some treatment options such as radical prostatectomy, which was performed less frequently in those with HIV-infection.…”

“…African American men are disproportionately represented among HIV-infected men, a population more vulnerable to health care disparities in comparison to uninfected men (5, 27, 28). A recent study in the HAART era found that HIV-infected men were largely appropriately treated in comparison to HIV-uninfected men, though under- or over-treatment sometimes occurred due to difficulty estimating life expectancy (27); disparities by HIV status remained for some treatment options such as radical prostatectomy, which was performed less frequently in those with HIV-infection. Although prostate cancer is becoming more prevalent among HIV-infected men in the HAART era, the effect of race on prostate cancer incidence in HIV-infected populations remains unknown.…”