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

Syim Salahuddin; Oded Cohen; Margaret Wu; Javier Perez Irizarry; Teresita Vega; Geliang Gan; Yanhong Deng; Natalia Isaeva; Manju Prasad; Kurt A Schalper; Saral Mehra; Wendell G Yarbrough; Brinda Emu

doi:10.1093/cid/ciac924

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

Clin Infect Dis. 2023 Apr 17;76(8):1449-1458. doi: 10.1093/cid/ciac924.

Authors

Syim Salahuddin¹, Oded Cohen², Margaret Wu³, Javier Perez Irizarry⁴, Teresita Vega⁴, Geliang Gan⁵, Yanhong Deng⁵, Natalia Isaeva⁶, Manju Prasad⁷, Kurt A Schalper⁷, Saral Mehra⁸, Wendell G Yarbrough^{6

9}, Brinda Emu^{1

7}

Affiliations

¹ Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
² Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Scarsdale, New York, USA.
³ Department of Pediatrics, Northwestern University, Chicago, Illinois, USA.
⁴ Yale Cancer Center, Yale New Haven Hospital, New Haven, Connecticut, USA.
⁵ Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, Connecticut, USA.
⁶ Department of Otolaryngology/Head and Neck Surgery and Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁷ Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA.
⁸ Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
⁹ Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Abstract

Background: Head and neck squamous cell cancer (HNSCC) occurs at higher rates among persons with HIV (PWH). This study compares the impact of sociodemographic and clinicopathologic characteristics on outcomes among PWH-HNSCC compared with HNSCC patients without HIV.

Methods: Patient data from HNSCC individuals were collected at a single academic hospital center between 2002 and 2018. Forty-eight patients with HIV (HIV-HNSCC) and 2894 HNSCC patients without HIV were included. Multivariate analysis determined predictors of survival using Cox proportional hazards regression model. HIV-positive and -negative tumors were analyzed by quantitative immunofluorescence for expression of CD4, CD8, CD20 and PD-L1.

Results: HIV-HNSCC patients had a lower median overall survival than HNSCC patients without HIV (34 [18-84] vs 94 [86-103] months; P < .001). In multivariate analysis that included age, sex, race/ethnicity, stage, site, tobacco use, time to treatment initiation, and insurance status, HIV was an independent predictor of poorer survival, with a hazard ratio of 1.98 (95% CI: 1.32-2.97; P < .001). PWH with human papillomavirus (HPV)-positive oropharyngeal tumors also had worse prognosis than HPV-positive oropharyngeal tumors in the population without HIV (P < .001). The tumor microenvironment among HIV-HNSCC patients revealed lower intratumoral CD8 infiltration among HIV+ HPV+ tumors compared with HIV- HPV+ tumors (P = .04).

Conclusions: HIV-HNSCC patients had worse prognosis than the non-HIV 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.

Keywords: HIV/HPV coinfection; head and neck cancer; non-AIDS-defining cancer; survival; tumor microenvironment.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Carcinoma, Squamous Cell* / pathology
Carcinoma, Squamous Cell* / therapy
HIV
Head and Neck Neoplasms* / complications
Humans
Oropharyngeal Neoplasms*
Papillomavirus Infections* / epidemiology
Prognosis
Squamous Cell Carcinoma of Head and Neck / complications
Tumor Microenvironment

Abstract

Publication types

MeSH terms

Grants and funding