Are HIV-Infected Men Vulnerable to Prostate Cancer Treatment Disparities?
Menée aux Etats-Unis auprès de 43 cas et 86 témoins, cette étude de cohorte rétrospective analyse l'impact des disparités dans les traitements d'un cancer de la prostate sur la survie des patients infectés par le VIH
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.