Cancer disparities in people with HIV: A systematic review of screening for non-AIDS-defining malignancies

Abstract

Background: People with HIV (PWHIV) have improved survival because of the advent of antiretroviral therapy. Consequently, PWHIV experience higher rates of non-acquired immunodeficiency syndrome-defining malignancies (NADMs). Previous studies have demonstrated worsened cancer-specific survival in PWHIV, partly because of advanced cancer stage at diagnosis. The objective of the current systematic review was to evaluate screening disparities for NADMs among PWHIV.

Methods: The PubMed, Cochrane, EMBASE, and ClinicalTrials.gov databases were searched from January 1, 1996 through April 10, 2018 to identify studies related to screening disparities for NADMs among PWHIV. Eligibility criteria included any study performed in a high-income country that compared screening for NADMs by HIV status. After title/abstract screening and full-text review, articles that met eligibility criteria were analyzed.

Results: Of 613 unique articles identified through the search, 9 studies were analyzed. Three studies addressed breast cancer screening, 4 addressed colorectal cancer screening, and 2 addressed prostate cancer screening. Five of the reviewed studies demonstrated that PWHIV were less likely to receive indicated cancer screenings compared with the general population, whereas 3 indicated that screening proportions were higher among PWHIV, and 1 demonstrated that screening proportions were comparable. In most of the studies, PWHIV who had regular access to health care were more likely to undergo cancer screening.

Conclusions: The available evidence does not uniformly confirm that PWHIV are less likely to receive cancer screening. Social determinants of health (insurance status, access to health care, education, income level) were associated with the receipt of appropriate cancer screening, suggesting that these barriers need to be addressed to improve cancer screening in PWHIV.

Keywords: acquired immunodeficiency syndrome; early detection of cancer; health care disparities; human immunodeficiency virus (HIV); social determinants of health.

Figure 1.

The prevalence of screen detectable non-acquired immunodeficiency syndrome (AIDS)-defining malignancies is illustrated among people living with human immunodeficiency virus in the United States.

Figure 2.

The excess risk of cancers among people living with human immunodeficiency virus in the United States is illustrated. The decreased risks of breast, prostate, and colorectal cancer may be reflective of underdiagnosis caused by a lack of appropriate screening. AIDS indicates acquired immunodeficiency syndrome.

Figure 3.

This is a flow diagram of study selection for the current review.