Impact of HIV status on overall survival in head and neck cancers by anatomical site and stage: A multi-center cohort study

Abstract

Objectives: People with human immunodeficiency virus (PWH) are at higher risk for head and neck cancer (HNC) than people without HIV (PWoH), but data on the survival effect of HIV are scarce. The objective is to compare survival for PWH vs. PWoH diagnosed with HNC, stratified by anatomical site and cancer stage.

Materials and methods: The multi-institutional U.S.-based retrospective analysis included HNC patients (296 PWH and 29,875 PWoH) diagnosed between 2008 and 2020. Statistical analysis reported 5-year overall survival and hazard ratios (HR) for all-cause mortality by HIV infection and CD4 counts for oropharyngeal cancer (OPC), oral cavity cancer (OC), and laryngeal and hypopharyngeal cancers (LHPC); with additional analysis stratified by HPV status and stage (I-IVB).

Results: Compared with PWoH, PWH were likely younger (median [IQR], 60[54-65] vs. 64[59-70] years; p < 0.001), male (98 % vs. 93 %; p = 0.003), black (39 % vs. 13 %; p < 0.001); and HPV+ tumors (25 % vs. 21 %; p = 0.041). The Kaplan-Meier mean survival in years for PWH versus PWoH were 3.41 vs. 3.78 for OPC, 3.78 vs. 3.40 for OC, and 3.50 vs. 3.44 for LHPC. In adjusted analysis, HIV-infection was associated with 43 % higher hazard of death for OPC (HR: 1.43 [95 % CI, 1.08-1.90]) but not associated with OC (HR: 0.74 [0.40-1.12]) and LHPC (HR: 0.98 [0.72-1.34]). For HPV-stratified analysis, higher hazards for both HPV+ (45 %) and HPV- (70 %) tumors. Similar trends were observed in stage-stratified and CD-based analyses.

Conclusion and relevance: HIV's association with poorer survival in OPC warrants further research to understand the factors contributing to this survival gap.

Keywords: Cancer stage; HIV; HPV; Head and neck cancer; Overall survival.