Human Immunodeficiency Virus Is Associated With Poor Overall Survival Among Patients With Head and Neck Cancer

Abstract

Background Head and neck squamous cell cancer (HNC) occurs at higher rates among people with HIV (PWH). This study compares the impact of sociodemographic and clinicopathologic characteristics on outcomes among PWH-HNSCC compared to Uninfected- HNSCC patients. Methods Patient data from individuals with HNSCC were collected at a single academic hospital center between 2002 and 2018. 48 patients with HIV infection (HIV-HNSCC) and 2894 uninfected patients (Uninfected-HNSCC) were included. Multivariate analysis determined predictors of survival using Cox proportional hazards regression model. HIV + and HIV- tumors were analyzed by quantitative immunofluorescence for expression of CD4, CD8, CD20 and PD-L1. Results HIV-HNSCC patients had lower median overall survival compared to Uninfected-HNSCC patients (34 [18-84] vs. 94 [86-103] months, p < 0.001). In a multivariate analysis that included age, sex, race/ethnicity, stage, site, tobacco use, time to treatment initiation, and insurance status, HIV infection was an independent predictor of poorer survival with a hazard ratio of 1.98 (95% CI 1.32-2.97, p < 0.001). PWH with HPV + oropharyngeal tumors also had worse prognosis compared to HPV + oropharyngeal tumors in the HIV-Uninfected population(p < 0.001). The tumor microenvironment among HIV-HNSCC patients revealed lower intra-tumoral CD8 infiltration among HIV + HPV + tumors compared to HIV-HPV + tumors (p = 0.04). Conclusions HNSCC patients with HIV had worse prognosis compared to the general population, with HIV being an independent predictor of poor clinical outcomes when accounting for important sociodemographic and clinicopathologic factors. Our findings highlight differences in tumor biology that require further detailed characterization in large cohorts and increased inclusion of PWH in immunotherapy trials.