Online Program

Are there treatment disparities in prostate cancer in HIV-infected men?

Monday, November 4, 2013

Adam Murphy, Dept. of Urology, Northwestern University, Chicago, IL
Ramona Bhatia, MD, Department of Preventive Medicine, Northwestern University, Chicago, IL
David Klein, MS, Feinberg School of Medicine, Northwestern University, Chicago, IL
Rick Kittles, PhD, Institute of Human Genetics, University of Illinois at Chicago, Chicago, IL
Chad Achenbach, Northwestern University, Chicago, IL
Background: Most HIV-infected (HIV+) persons will soon be over age 50 and vulnerable to prostate cancer (PCa). HIV+ patients are at risk for cancer undertreatment. We compared PCa treatments received in HIV+ and HIV-uninfected (HIV-) men. Methods: We developed a retrospective cohort of 43 HIV+ and 86 matched HIV- PCa patients seen at an academic hospital. We compared rates of appropriate treatment based on National Comprehensive Cancer Network (NCCN) guidelines and radical prostatectomy (RP). Results: The median age was 59 years and follow-up time was 7.5 years. Overall, 58% were Caucasian and 29% Black. Among cases, median CD4 cell count (CD4) was 367 cells/mm3, 98% received antiretroviral therapy, and 90% were virally suppressed. Median prostate specific antigen levels were similar between groups (p = 0.47). Overall, 56.8% of HIV+ and 46.5% of HIV- men (p = 0.30) had NCCN-defined low-risk PCa. No undertreatment occurred; however 3 HIV+ cases were overtreated based on life expectancy. RP utilization was lower in cases, and this persisted in cases with high calculated life expectancy (38.6% vs. 70.9%, p < 0.001). HIV+ status positively associated with receiving RP when adjusting for age, Charlson co-morbidity index score, body mass index, race, CD4, and viral suppression (OR = 0.31, CI: 0.13-0.74). All-cause mortality was non-significantly higher in cases (11.9 vs. 7.4/1000 person-years, p = 0.47). Conclusion: HIV is not associated with PCa undertreatment, but is associated with lower RP utilization among men with adequate life expectancy. Studies on etiologies and outcomes of this treatment disparity are warranted.

Learning Areas:

Provision of health care to the public

Learning Objectives:
Discuss that At an academic institution it appears that HIV infected men are not undertreated for prostate cancer.

Keyword(s): Cancer, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator of some federally funded grants focusing on the epidemiology of health disparities in urologic diseases and am a new investigator training to focus on HIV related research. Among my scientific interests has been revealing potential treatment disparities faced by HIV infected patients and discerning if HIV predisposes patients to develop prostate cancer or more aggressive prostate cancer relative to the non-infected population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.