Hazard of cervical, oropharyngeal, and anal cancers in HIV-infected and HIV-uninfected medicaid beneficiaries

Abstract

Background: Human immunodeficiency virus–infected (HIVþ) individuals are disproportionately at risk for human papillomavirus (HPV)-associated cancers, but the magnitude of risk estimates varies widely. We conducted a retrospective study using a large U.S.-based cohort to describe the relationship between HIV infection and incident cervical, oropharyngeal, and anal cancers. Methods: Using 2001–2012 U.S. Medicaid data from 14 states, we matched one HIVþ to three HIV-uninfected (HIV) enrollees on sex, race, state, age, and year, and followed persons for up to 10 years. We developed Cox proportional hazards models comparing HIVþ 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 HRs: cervical cancer, 3.27 [95% confidence interval (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: HIVþ 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.