Effectiveness and toxicity of head and neck cancer treatment among people with HIV in Brazil

Purpose: The incidence of head and neck squamous cell carcinoma (HNSCC) is rising among people with HIV (PWH). Previous studies have shown increasing treatment-related toxicities in this population. This study aims to determine the demographics and treatment outcomes at a tertiary cancer center in Brazil. Methods: patients with HNSCC and HIV treated at our institution between 2009 and 2022 were included. Medical charts were analyzed to extract clinical data. Log rank was used to compare survival estimates and a stratified Cox regression model for univariate and multivariate analyses. Results: We identified 75 patients with HIV among 5956 with HNSCC. Median age at cancer diagnosis was 53 years (IQR 49–59.5), 80% were male, and 82.7% had a smoking history. Most had an oropharynx primary tumor (38.7%) and locally advanced disease (80%), HIV viral load was detectable in 30.7%, and 25.3% had CD4 <200 cells/mm3, while 97.3% were on combination antiretroviral therapy. Concurrent cisplatin-based chemoradiation (CRT) was prescribed to 34.7%, and 45.3% received radiotherapy (RT) alone. No patients with positive viral load or CD4 <200 cells/mm3 were able to complete CRT. Positive viral load was associated with lower cisplatin dosing (p = 0.03), and CD4 <200 cells/mm3 increased the risk of death during treatment (p = 0.02). Multivariate analysis did not show a statistically significant decrease in OS in patients with positive viral load or CD4 <200 cells/mm3. Conclusions: HNSCC treatment in PWH is associated with a high discontinuation rate, toxicity, and death during treatment. Positive viral load and low CD4 count were considered contributing factors.