JMIR Publications

ABSTRACT

Background:

People living with HIV (PLWH) are at increased risk for developing cancer, a leading cause of death among this population. The management of cancer in this population is particularly challenging, necessitating specialized, interdisciplinary care. However, insights into cancer care provision for PLWH in Germany remain scarce.

Objective:

This study analyzes inpatient cancer care for PLWH in Germany, comparing treatment patterns and complications with those of an HIV-negative control group. Using claims data from three German university hospitals, we aim to identify care disparities and provide evidence to support improved cancer management.

Methods:

A federated approach was used to process site-specific claims data, including demographics, diagnoses, and treatment codes. Employing nearest-neighbor matching we analyzed demographic features, cancer incidence, anticancer therapies, and outcomes in PLWH with cancer and for a control group of HIV-negative cancer patients.

Results:

Among 148,648 patients, 850 were PLWH with cancer. Cancer incidence declined over time, particularly for AIDS-defining cancers (total cancer diagnoses: P = .001; AIDS-defining cancers: P = .002), with a shift toward older age at diagnosis. Compared to matched controls, PLWH with cancer had longer hospital stays and experienced more post-chemotherapy complications (Cancer+/HIV+, 15.2%; 95% CI, 11.9 to 18.8; Cancer+/HIV-, 4.8%; 95% CI, 3.0 to 7.2). PLWH with cancer also showed increased mortality, although mortality declined over time (P = .02).

Conclusions:

While cancer incidence and mortality among PLWH in Germany have decreased, disparities in treatment and outcomes persist. Our findings underscore the need for tailored, multidisciplinary care strategies to improve cancer management for this population.