Abstract D092: Racial disparities in HIV-associated lymphoma
Authors: Calip Gregory S , Zhou Jifang , Sweiss Karen I , Patel Pritesh R , Ith Sina , Hubbard Colin C , Ko Naomi Y , Chiu Brian C-H 
Published: September 2020

Abstract
Introduction: Human immunodeficiency virus (HIV)-related lymphomas are more frequently diagnosed at advanced stages and HIV is associated with lower survival in Hodgkin and non-Hodgkin lymphoma. Less is documented on how the impacts of HIV on lymphoma outcomes differ between racial groups in the United States. Methods: We conducted a hospital-based retrospective cohort study of adults ages 18 years and older diagnosed with Hodgkin and non-Hodgkin lymphoma between 2004 and 2016 using the National Cancer Database. Information on demographic, socioeconomic and clinical characteristics were collected including histologic subtype, stage, initial treatments and whether lymphoma diagnoses were HIV-associated and/or patients were HIV positive. For the three most frequent HIV-associated lymphoma subtypes – Hodgkin lymphoma (HL), diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL) – modified Poisson regression models were used to estimate adjusted rate ratios (RR) and 95% confidence intervals (CI) for the race-specific impacts of HIV on risk of advanced stages, B-symptoms at diagnosis, and receipt of chemo-immunotherapy. We measured Kaplan Meier survivor functions and estimated adjusted hazard ratios (HR) and 95% CI for the impact of HIV on overall survival by race in Cox proportional hazards models. Results: From an overall cohort of 579,123 lymphoma patients, 18,826 (3.3%) were HIV-associated. Compared to patients with non-HIV-associated lymphoma, HIV positive patients were younger (median 47 vs. 64 years) and more likely to be male (77% vs. 54%), black (34% vs. 8%), Hispanic (15% vs. 6%), have Medicaid or be uninsured (35% vs. 10%) and live in zip codes with the lowest quartile of median income (30% vs. 16%) and lowest quartile of attained education (34% vs. 19%). Among patients with HIV-associated lymphomas, black and Hispanic patients were diagnosed at lower median ages (45 and 44 years, respectively) compared to white patients (49 years). Rates of chemo-immunotherapy treatment for HIV-associated lymphoma were lower among black (68%) and Asian/Pacific Islander patients (63%) compared to white patients (73%). Black patients with HIV-associated lymphomas had consistently lower five-year survival across subtypes, a trend not seen with non-HIV-associated lymphomas. In multivariable models accounting for differences in stage and treatment, HIV was associated with a 33% increase (95% CI 10% to 61%) in risk of all-cause mortality among black patients with HL. Among white, Hispanic and Asian/Pacific Islander patients with HL, HIV was not associated with a statistically significant increase in overall mortality. Conclusions: Among HIV-associated lymphoma patients, we observed racial differences in outcomes with black patients experiencing the lowest five-year survival, a trend not seen in non-HIV-associated lymphomas. In adjusted analyses, HIV was associated with significantly increased overall mortality among black patients with HL but not in other racial groups.
Citation Format: Gregory S Calip, Jifang Zhou, Karen I Sweiss, Pritesh R Patel, Sina Ith, Colin C Hubbard, Naomi Y Ko, Brian C-H Chiu. Racial disparities in HIV-associated lymphoma [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D092.