Survival among medically insured and treated head and neck cancer patients with and without HIV in South Africa.

OBJECTIVES: To assess the association of HIV and overall survival among medically insured head and neck cancer (HNC) patients in South Africa and to examine factors associated with the type of treatment received. METHODS: We used reimbursement claims data from a South African medical insurance scheme database from 1 January 2011 to 1 July 2020. We included individuals with at least two International Classification of Diseases (ICD-10) codes for HNC and at least one cancer treatment code within 180 days of the HNC diagnosis. We used logistic regression to identify factors associated with receiving a specific type of cancer treatment and Cox proportional hazards models to examine factors associated with all-cause mortality. RESULTS: We included 566 HNC patients, 49 of whom lived with HIV and 383 were male. Patients with HIV were substantially younger at HNC diagnosis (median age: 52.5 years) than patients without HIV (median age: 61.6 years). We found no clear association between HIV status and the treatment type received. The median survival was 3.78 years (95% confidence interval [CI] 3.01-6.08) and the five-year survival was 46.0% (95% CI 41.2%-51.5%). The risk of death was higher among patients with HIV than those without HIV (adjusted hazard ratio 1.68; 95% CI 1.00-2.81). CONCLUSION: Medically insured HNC patients in South Africa with HIV had higher mortality than those without HIV. This underscores the importance of tailored cancer care strategies for HNC patients with HIV.