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Treatment and Outcomes of Oropharyngeal Cancer in People with Human Immunodeficiency Virus.

Authors
  • Brickman, Cristina E1
  • Propert, Kathleen J2
  • Merlin, Jessica S3
  • Liu, Jeffrey C4
  • Eady, Sequoya3
  • Mcghee-Jez, Amy5
  • Ragin, Camille6
  • Grover, Surbhi7
  • Cohen, Roger B8
  • Gross, Robert1
  • 1 Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • 2 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
  • 3 Division of Infectious Diseases, Department of Medicine, the University of Alabama at Birmingham, Birmingham, Alabama.
  • 4 Department of Otolaryngology, Temple University, Philadelphia, Pennsylvania.
  • 5 Division of Hematology and Oncology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • 6 Fox Chase Cancer Center at Temple University, Philadelphia, Pennsylvania.
  • 7 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
  • 8 Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Type
Published Article
Journal
AIDS Research and Human Retroviruses
Publisher
Mary Ann Liebert
Publication Date
Oct 01, 2019
Volume
35
Issue
10
Pages
934–940
Identifiers
DOI: 10.1089/AID.2019.0009
PMID: 31347379
Source
Medline
Keywords
Language
English
License
Unknown

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.

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