Risk and Incidence of Head and Neck Cancers in Veterans Living With HIV and Matched HIV-Negative Veterans

Authors

Angela L Mazul
Christine M Hartman
Yvonne M Mowery
Jennifer R Kramer
Donna L White
Kathryn E Royse
Suchismita Raychaudhury
Vlad C Sandulache
Sarah T Ahmed
Jose P Zevallos
Peter A Richardson
Andrew G Sikora
Elizabeth Y Chiao

Publication Date

9-15-2022

Journal

Cancer

DOI

10.1002/cncr.34387

PMID

35867552

PMCID

PMC10650941

PubMedCentral® Posted Date

11-15-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Carcinoma, Squamous Cell, Cohort Studies, HIV Infections, Head and Neck Neoplasms, Humans, Incidence, Oropharyngeal Neoplasms, Papillomaviridae, Papillomavirus Infections, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck, United States, Veterans, Head and neck cancer, People Living with HIV/AIDS, Veteran Health Administration

Abstract

BACKGROUND: Persons living with HIV/AIDS have a higher incidence of virus-related and tobacco/alcohol-related cancers. This study is the first to estimate the effect of HIV versus HIV-negative veterans on the risk of head and neck squamous cell carcinoma incidence in a large retrospective cohort study.

METHODS: The authors constructed a retrospective cohort study using patient data from 1999 to 2016 from the National Veterans Administration Corporate Data Warehouse and the VA Central Cancer Registry. This cohort study included 45,052 veterans living with HIV/AIDS and 162,486 HIV-negative patients matched by age, sex, and index visit (i.e., HIV diagnosis date or clinic visit date). The age-standardized incidence rates and estimated adjusted hazard ratios were calculated with a Cox proportional hazards regression for oropharyngeal and nonoropharyngeal head and neck cancer squamous cell carcinoma (HNSCC). The authors also abstracted human papillomavirus (HPV) status from oropharyngeal HNSCC diagnosed after 2010.

RESULTS: Veterans living with HIV/AIDS (VLWH) have 1.71 (95% confidence interval [CI], 1.36, 2.14) times the risk of oropharyngeal cancer and 2.06 (95% CI, 1.76, 2.42) times the hazard of nonoropharyngeal cancer compared with HIV-negative veterans. VLWH with oropharyngeal squamous cell carcinoma (OPSCC) were more likely to be HPV-positive (N = 30 [81.1%]) than the HIV-negative veterans with OPSCC (N = 50 [67.6%]), although this difference was not significant (p = .135). For nonoropharyngeal cancer, the increased risk of oral cavity cancer among VLWH drove the increased risk.

CONCLUSIONS: The study results suggest that HIV may play a role in virally mediated and nonvirally mediated HNSCC. As the HIV prevalence rises in the United States due to better survival and the incidence of HPV-positive oropharyngeal HNSCC increases, the interaction between HPV and HIV becomes increasingly relevant.