Background: Human immunodeficiency virus (HIV) and end stage renal disease (ESRD) are established risk factors for malignancy. Previous work found that over 8% of HIV+ ESRD patients from 2005 to 2011 developed select malignancies with the most common being non-Hodgkins lymphoma, Kaposi sarcoma, and colorectal cancer. This study aimed to determine the risk of malignancy associated mortality and the risk factors for all-cause mortality among HIV+ ESRD patients with cancer.
Methods: The United States Renal Data System was queried for all incident dialysis cases from 2005 to 2011 with diagnoses of HIV and common malignancies. ICD-9 codes were used to identify all diagnoses. Cox Proportional Hazards models were used to calculate the adjusted hazard ratio (aHR) of cancer diagnosis in all HIV+ ESRD patients and the aHR of selected demographics and clinical comorbidities in HIV+ ESRD patients with cancer.
Results: 6,641 HIV+ ESRD patients were identified from 2005 to 2011. During this period, 51.7% of patients died; common primary causes of death in this population included septicemia (11.0%) and malignancy (3.8%). Within the HIV+ ESRD cohort, 543 patients (8.2%) were diagnosed with any malignancy for a total 603 cancer diagnoses. Any cancer diagnosis was associated with an increased risk of death (aHR 1.29) as illustrated in the figure below. In particular, non-Hodgkins lymphoma significantly increased the risk for death (aHR 1.42). Among patients who developed cancer (n=543), septicemia (8.5%) and malignancy (22.0%) remained commonly identified primary causes of death. Factors related to an increased risk of death among all patients with cancer included older age (aHR 1.02), pneumonia any time after HIV diagnosis (aHR 1.52), and septicemia after cancer diagnosis (aHR 1.50).
Conclusion: After adjusting for comorbidities, any cancer diagnosis among HIV+ ESRD patients was associated with a 1.29-fold increased risk of death. Pneumonia after HIV diagnosis and septicemia after cancer diagnosis were major risk factors for death. Awareness of common causes of death and risk factors for death in this population can help guide clinician attention and improve patient outcomes.
S. Baer, None
V. Spearman, None
M. Kheda, None
L. Young, None
N. S. Nahman Jr., None
R. Colombo, None