Hazard of Cervical, Oropharyngeal, and Anal Cancers in HIV-infected and HIV-uninfected Medicaid Beneficiaries
Menée aux Etats-Unis à partir de données 2001-2012 de la base Medicaid portant sur des témoins séronégatifs et 564 389 personnes séropositives au VIH (âge moyen : 39-41 ans ; durée moyenne de suivi : 3,4 ans), cette étude analyse le risque, lié au virus, de cancer du col de l'utérus (828 cas), de l'oropharynx (713 cas) et de l'anus (649 cas)
Background: HIV+ individuals are disproportionately at risk for HPV-associated cancers, but the magnitude of risk estimates varies widely. We conducted a retrospective study using a large United States-based cohort to describe the relationship between HIV infection and incident cervical, oropharyngeal, and anal cancers. Methods: Using 2001 - 2012 US Medicaid data from fourteen states, we matched one HIV+ to three HIV- enrollees on sex, race, state, age, and year, and followed persons for up to ten years. We developed Cox proportional hazards models comparing HIV+ to HIV- for time to cancer diagnosis adjusted for demographic and comorbidity attributes. Results: Our cohorts included 443,592 women for the cervical cancer analysis, and 907,348 and 906,616 persons for the oropharyngeal and anal cancer analyses. The cervical cancer cohort had a mean age of 39 years and was 55% Black. The oropharyngeal and anal cancer cohorts were 50% male, had a mean age of 41 years, and were 51% Black. We estimated the following hazard ratios: cervical cancer, 3.27 (95% CI 2.82 - 3.80); oropharyngeal cancer, 1.90 (95% CI 1.62 - 2.23) (both sexes), 1.69 (95% CI 1.39 - 2.04) (males), and 2.55 (95% CI 1.86 - 3.50) (females); and anal cancer, 18.42 (95% CI 14.65 - 23.16) (both sexes), 20.73 (95% CI 15.60 - 27.56) (males), and 12.88 (95% CI 8.69 - 19.07) (females). Conclusions: HIV+ persons were at an elevated risk for HPV associated cancers, especially anal cancer. Impact: Medicaid claims data corroborate previous estimates based on registries and clinical cohorts.