An ounce of prevention: Medicaid's role in reducing the burden of cancer in men with HIV

Abstract

One of the more remarkable joint public health and medical achievements of the past several decades is the decline in annual incident HIV cases (an 8% decrease between 2015 and 2019) 1 coupled with an improved survival period after HIV diagnosis that approaches the lifespan of the general population. 2 Although highly active antiretroviral treatment (HAART) is the primary reason survival has improved to previously unimagined longevity, people living with HIV (PLWH) often suffer from comorbid conditions that limit their ability to live their lives as they would have in the absence of HIV. PLWH are also more likely to be persons of color, men who have sex with men, transgender women, people who inject drugs, and people with lower socioeconomic status. Given the complex clinical, patient, social, and health care system factors that affect health risks, access to care, and care coordination for PLWH, it is essential to understand patterns of serious and high-cost comorbid conditions to inform strategies for prevention and management among providers, health care payers, and policymakers.In this issue of Cancer, Koroukian et al report excess cancer in men living with HIV (MLWH) and insured by Medicaid. 3 Strikingly, the prevalence of cancer was nearly twice as high in MLWH as in men without a diagnosis of HIV. In this national sample of MLWH, lymphoma and anal cancer were the most prevalent cancers, although MLWH also had an excess prevalence of other cancers, including cancers of the esophagus and rectum, as well as a higher prevalence of leukemia, relative to a sample of men without HIV. This finding underscores the need to better understand risk factors among PLWH so that cancer can be prevented and, if not prevented, detected early, when treatment is most effective. The findings also draw attention to the experiences of a growing survivorship population, one that lives with both HIV and cancer.Koroukian and colleagues' study sample was drawn from the national Medicaid Analytic eXtract file, which includes data from fee-for-service plans and health maintenance organizations. This is a highly relevant sample to study because Medicaid provides health insurance coverage for approximately 42% of PLWH 4 who, in all likelihood, will age into Medicare coverage if they do not qualify as dually eligible for both programs before age 65 years. Together, federal funding for HIV/AIDS care under the Medicaid and Medicare programs was >$17 billion in 2019. 4 By using Medicaid claims data, the researchers used International Classification of Diseases, Ninth Revision, diagnosis codes to identify HIV status and 13 common cancers. They further stratified the sample by symptomatic and asymptomatic HIV, age, and race/ethnicity to examine differences within these important subgroups who may disproportionately experience adverse effects of HIV and cancer and who also may face inequities in receipt of health care. The burden of cancer was not shared equally across the sample of MLWH. Hispanic men, a group that is relatively understudied,...