Excess cancer prevalence in men with HIV: A nationwide analysis of Medicaid data

Koroukian, Siran M.; Navale, Suparna M.; Schiltz, Nicholas K.; Kim, Uriel; Rose, Johnie; Cooper, Gregory S.; Moore, Scott Emory; Mintz, Laura Janine; Avery, Ann; Mukherjee, Sudipto; Markt, Sarah C.

doi:10.1002/cncr.34166

Cited by 11 publications

(14 citation statements)

References 26 publications

(45 reference statements)

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“…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.…”

Section: Figurementioning

confidence: 99%

“…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.…”

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confidence: 99%

“…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.…”

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confidence: 99%

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

Sabik

2022

Cancer

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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,...

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Section: Figurementioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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

Sabik

2022

Cancer

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“…Men who have sex with men (MSM) with HIV have a very high risk (85 to 300-fold) of developing anal cancer [1,2]. The early detection and treatment of anal high-grade squamous intraepithelial lesions (HSILs), precursors to anal cancer, can significantly reduce this risk [3].…”

Section: Introductionmentioning

confidence: 99%

The microbiome as a biomarker of anal precancerous lesions in people with HIV

Ron,

Moreno,

Rosas Cancio-Suárez

et al. 2023

Current Opinion in Infectious Diseases

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Purpose of review Early detection and treatment of human papillomavirus (HPV)-related anal dysplasia in some high-risk groups can help anal cancer prevention, but new tools to improve diagnostic and risk assessment are needed. Here, we aim to discuss the evidence on the role of the microbiome as a potential biomarker for anal high-grade squamous intraepithelial lesions (HSILs) in people with HIV (PWH). Recent findings This review covers relevant studies on the links between the microbiome and HPV infection, cervical dysplasia/cancer, and anal HPV disease. It focuses on anal samples and precancerous lesions. Summary The review highlights the promising potential of the anal microbiome as a novel biomarker for precancerous lesions in people with HIV, while also discussing limitations and future research needs.

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“…Men who have sex (MSM) with men with HIV exhibit a surprisingly high (85 to 300-fold) risk of anal cancer 1,2 , yet accurate screening of at-risk patients is lacking. Given the correlations between HIV 3,4 , sexual preferences 5,6 , HPV-associated lesions 7,8 , and the microbiome, we face the opportunity and challenge of studying anal bacterial communities as a potential source of diagnostic biomarkers for anal cancer prevention [8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Microbiome-Derived Cobalamin and Succinyl-CoA are Powerful Biomarkers for Improved Screening of Anal Cancer

Serrano‐Villar

Sáenz

Tincati

et al. 2022

Preprint

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Background. People with HIV (PWH) exhibit a markedly increased risk of anal cancer, especially men who have sex with men (MSM), with specific microbiota signatures possibly contributing to greater human papillomavirus (HPV) oncogenic potential. Low specificity of the current screening strategy for detecting high-grade squamous intraepithelial lesions (HSIL) hinders anal cancer prevention. We investigated microbiome derivatives associated with HSIL in anal cytology samples. Methods. We recruited a discovery and a validation cohort at four clinical sites in Spain and Italy. Study participants were mostly MSM undergoing HSIL screening with high-resolution anoscopy and anal biopsies to confirm HSIL. We extracted the bacterial DNA, proteins, and metabolites from anal cytology samples, and we performed 16SrRNA gene sequencing, mass spectrometry, and targeted metabolite quantification. Results. We included 213 participants, 167 in the discovery cohort (70 with confirmed HSIL) and 46 in the validation cohort (25 with confirmed HSIL). While we did not find clear microbiome composition signatures associated with HSIL, the microbiome associated with HSIL overexpressed proteins involved in the production of succinyl-CoA and cobalamin, with levels consistently increased in subjects with HSIL in the discovery and validation cohorts. Combined measurement of succinyl-CoA and cobalamin overperformed anal cytology, improving sensitivity from 91.2% to 96.6%, specificity from 34.1% to 81.8%, positive predictive value from 48.1% to 77.8%, and negative predictive value from 85.3% to 97.3%. While anal cytology correctly classified only 59.9% of individuals, combined measurement of both metabolites improved the classification to 87.7%. This test overcame internal (adjusted AUC 0.877) and external validation. From 98 false-positive cytologic results, succinyl-CoA and cobalamin level measurement reclassified 49 (50%) to true negatives. Finally, we demonstrate greater in vitro production of succinyl-CoA and cobalamin in bacteria associated with HSIL or cancer vs. those presumably protective. Conclusions. Cobalamin and succinyl-CoA are overexpressed in the anal microbiome of patients with HSIL and show excellent diagnostic capacity. Their measurement overperforms anal cytology to screen for patients with HSIL. Hence, we discovered two powerful biomarkers for which detection methods can readily be established, that could improve the current strategy of anal cancer screening.

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Excess cancer prevalence in men with HIV: A nationwide analysis of Medicaid data

Cited by 11 publications

References 26 publications

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

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

The microbiome as a biomarker of anal precancerous lesions in people with HIV

Microbiome-Derived Cobalamin and Succinyl-CoA are Powerful Biomarkers for Improved Screening of Anal Cancer

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