# Clinical Epidemiology of Cancer in People Living With HIV in Germany: Retrospective, Observational, Multicenter Federated Claims Data Analysis

## TL;DR

People living with HIV in Germany face higher cancer risks and worse outcomes compared to HIV-negative individuals, highlighting the need for specialized care.

## Contribution

This study provides the first comprehensive analysis of cancer care disparities in people living with HIV in Germany using federated claims data.

## Key findings

- People living with HIV and cancer had longer hospital stays and more postchemotherapy complications than HIV-negative cancer patients.
- HIV-positive cancer patients showed higher rates of metastasis and in-hospital mortality, though mortality decreased over time.
- HIV-positive patients received more chemo- and immunotherapy but less surgery compared to controls.

## Abstract

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

This study analyzed inpatient cancer care for people living with HIV, comparing treatment patterns and complications with those of an HIV-negative control group. Using claims data from 3 German university hospitals related to admissions between 2005 and 2022, we aimed to identify care disparities and provide evidence to support improved cancer management.

A customized federated approach was used to analyze inpatient claims data of patients across the 3 data-holding institutions. The data included demographics, diagnoses, procedures, and treatment codes as well as discharge information. Using nearest-neighbor matching, we analyzed demographic features, cancer diagnoses, anticancer therapies, and outcomes in people living with HIV and cancer and for a control group of HIV-negative patients with cancer.

Among 162,380 patients, 907 (0.6%) were people living with HIV and cancer. The count of cancer diagnoses 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 with matched controls, people living with HIV and cancer had longer hospital stays, experienced more postchemotherapy complications (cancer with HIV: 64/907, 15.6%; cancer without HIV: 20/907, 5.5%; P<.001), and showed higher rates of metastasis after initial diagnosis (cancer with HIV: 128/267, 47.9%; cancer without HIV: 97/287, 33.8%; P<.001). People living with HIV and cancer also showed increased in-hospital mortality, although mortality declined over time (P=.02). Our data suggested differences in documented therapy modalities between the compared groups, with people living with HIV and cancer receiving more chemo- and immunotherapy and less surgery.

Using federated analysis techniques, we were able to show that cancer diagnoses and mortality among people living with HIV in Germany have decreased over time; however, disparities in treatment and outcomes persisted as compared with HIV-negative patients with cancer. Our findings underscore the need for tailored, multidisciplinary care strategies to improve cancer management for this population.