Receipt of guideline concordant oncologic care between older HIV-positive and older HIV-negative patients with cancer.

Abstract

e23067 Background: Given the success of anti-retroviral therapy (ART), the population of people living with HIV (PLWH) is aging. More than half of PLWH are over the age of 50. The median age of PLWH using ART is projected to be 52 years by 2030. PLWH experience worse outcomes with cancer diagnoses and are less likely to receive standard-of-care treatment as compared to non-HIV patients. We conducted a retrospective analysis to determine whether older (≥50 years old) PLWH (OPLWH) are treated as per guideline-concordant oncologic care as compared to HIV-negative older patients (HNOP). Methods: A single institution retrospective review in which OPLWH and HNOP diagnosed with diffuse large B cell lymphoma (DLBCL), non-small cell lung cancer (NSCLC), hepatocellular carcinoma (HCC), and cholangiocarcinoma between the years of 2015-2022 were identified using our institutional cancer registry. National Comprehensive Cancer Network (NCCN) guidelines from the corresponding year of diagnosis were used to assess if patients were offered and received guideline concordant oncologic care. Chi square test was performed to compare characteristics between populations. Multivariable logistic regression models were used to assess factors associated with being offered, receiving, and tolerating guideline concordant cancer therapy. Adjusted odds ratio (aOR) and 95% CI were used to quantify the effect of these associations. Results: We evaluated 238 patients: 78 OPLWH and 160 HNOP. The median age for OPLWH was 61 years (56-66) and HNOP was 65 years (59-71). 65/78 (83%) of OPLWH were Black as compared to 64/160 (40%) of HNOP. 71/78 (91%) of OPLWH were offered guideline concordant care as compared to 150/160 (93%) HNOP (p = 0.446). OPLWH had lower odds of receiving guideline concordant care compared to HNOP (84% vs 91%, p = 0.128), though results were not statistically significant. Of the patients that received care, 57/66 (86.4%) of OPLWH and 137/146 (93.8%) of HNOP tolerated treatment (p = 0.08). Compared to those with public health insurance, patients without health insurance were less likely to be offered guideline-concordant care (77.8% vs 92.8%; p = 0.134), as well as less likely to receive (66.7% vs 91.9%; p = 0.06), and tolerate treatment (66.7% vs 91.9%; p = 0.06) although the association was not statistically significant. Conclusions: There was no significant difference in the provision of guideline-concordant care between OPLWH and HNOP diagnosed with DLBCL, NSCLC, and hepatobiliary cancers. Patients in both groups received and tolerated therapy comparably. To our knowledge, this is the first study examining provision of guideline concordant care in PLWH. Our findings suggest progress in providing evidence-based treatment to OPLWH. Uninsured status may be more of a barrier to receipt of treatment as compared to HIV status alone.