Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Jan 1;95(1):26-34.
doi: 10.1097/QAI.0000000000003318.

Comparing Cancer Incidence in an Observational Cohort of Medicaid Beneficiaries With and Without HIV, 2001-2015

Jacqueline E Rudolph  1 , Keri L Calkins  1   2 , Xiaoqiang Xu  3 , Eryka Wentz  1 , Filip Pirsl  1 , Kala Visvanathan  1 , Bryan Lau  1 , Corinne E Joshu  1
Affiliations
Observational Study

Comparing Cancer Incidence in an Observational Cohort of Medicaid Beneficiaries With and Without HIV, 2001-2015

Jacqueline E Rudolph et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Life expectancy among people with HIV (PWH) is increasing, making chronic conditions-including cancer-increasingly relevant. Among PWH, cancer burden has shifted from AIDS-defining cancers (ADCs) toward non-AIDS-defining cancers (NADCs).

Setting: We described incidence of cancer in a claims-based cohort of Medicaid beneficiaries. We included 43,426,043 Medicaid beneficiaries (180,058 with HIV) from 14 US states, aged 18-64, with >6 months of enrollment (with no dual enrollment in another insurance) and no evidence of a prveious cancer.

Methods: We estimated cumulative incidence of site-specific cancers, NADCs, and ADCs, by baseline HIV status, using age as the time scale and accounting for death as a competing risk. We compared cumulative incidence across HIV status to estimate risk differences. We examined cancer incidence overall and by sex, race/ethnicity, and calendar period.

Results: PWH had a higher incidence of ADCs, infection-related NADCs, and death. For NADCs such as breast, prostate, and colon cancer, incidence was similar or higher among PWH below age 50, but higher among those without HIV by age 65. Incidence of lung and head and neck cancer was always higher for female beneficiaries with HIV, whereas the curves crossed for male beneficiaries. We saw only small differences in incidence trends by race/ethnicity.

Conclusion: Our findings suggest an increased risk of certain NADCs at younger ages among PWH, even when compared against other Medicaid beneficiaries, and highlight the importance of monitoring PWH for ADCs and NADCs. Future work should explore possible mechanisms explaining the differences in incidence for specific cancer types.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Cumulative incidence of AIDS-defining cancers, non-AIDS-defining cancers, and death by HIV status (A) overall and among (B) female beneficiaries, (C) male beneficiaries, (D) non-Hispanic Black beneficiaries, (E) non-Hispanic white beneficiaries, and (F) Hispanic beneficiaries.
Figure 2.
Figure 2.
Cumulative incidence of NADCs that are common in the general US population by sex. Note that the range of the y-axes differ, to highlight the observed trends by HIV status.
Figure 3.
Figure 3.
Cumulative incidence of select NADCs by sex. Note that the range of the y-axes differ, to highlight the observed trends by HIV status.
See this image and copyright information in PMC

References

    1. Edwards JK, Cole SR, Breger TL, et al. Mortality Among Persons Entering HIV Care Compared With the General U.S. Population : An Observational Study. Ann Intern Med. Published online July 6, 2021. doi:10.7326/M21-0065 - DOI - PMC - PubMed
    1. Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8(12):e81355. doi:10.1371/journal.pone.0081355 - DOI - PMC - PubMed
    1. Shiels MS, Islam JY, Rosenberg PS, Hall HI, Jacobson E, Engels EA. Projected Cancer Incidence Rates and Burden of Incident Cancer Cases in HIV-Infected Adults in the United States Through 2030. Ann Intern Med. 2018;168(12):866–873. doi:10.7326/M17-2499 - DOI - PMC - PubMed
    1. Coghill AE, Engels EA, Schymura MJ, Mahale P, Shiels MS. Risk of Breast, Prostate, and Colorectal Cancer Diagnoses Among HIV-Infected Individuals in the United States. J Natl Cancer Inst. 2018;110(9):959–966. doi:10.1093/jnci/djy010 - DOI - PMC - PubMed
    1. Adih WK, Selik RM, Hall HI, Babu AS, Song R. Associations and Trends in Cause-Specific Rates of Death Among Persons Reported with HIV Infection, 23 U.S. Jurisdictions, Through 2011. Open AIDS J. 2016;10:144–157. doi:10.2174/1874613601610010144 - DOI - PMC - PubMed

Publication types