A recent study published in CANCER indicates that for patients with both HIV and cancer, implementation of the Patient Protection and Affordable Care Act (ACA) improved insurance coverage, both in states that expanded Medicaid coverage and in states that did not.1

The study, conducted by a team led by Gita Suneja, MD, MSHP, at the Duke University School of Medicine, is the first to research the benefits of the ACA on insurance coverage and cancer treatment in patients with HIV.1

According to the National Cancer Institute, people infected with HIV have a significantly higher risk for some types of cancer, called HIV-associated cancers. These include Kaposi sarcoma, aggressive B-cell non-Hodgkin lymphoma, and cervical cancer, which are known as AIDS-defining cancers or AIDS-defining malignancies.2

This increased risk can be attributed to the weakened immune system of patients with HIV, and their increased susceptibility to several viruses that are most likely to cause cancer, according to the study. The prevalence of some risk facts for cancer is also higher among individuals with HIV, including smoking and heavy alcohol use.2

The researchers defined states that exercised the option to expand Medicaid eligibility to adults with incomes up to 138% of the federal poverty level or developed new state plans under the ACA as expansion states. States that did not fully expand Medicaid by 2015 were defined as non-expansion states. They also established 2 eras—the pre-ACA era was defined as 2011-2013, and the post-ACA era was 2014-2015.

The study authors found that of 4794 US adults with HIV who were diagnosed with cancer between 2011 and 2015, 49% lived in non-expansion states and were more often uninsured, non-white, and low income when compared with those in expansion states.

In the post-ACA era, the percentage of people living with both HIV and cancer who were uninsured decreased in expansion states from 4.9% to 3% and in non-expansion states from 17.6% to 14.6%. The researchers noted that this difference may be attributable to increased Medicaid coverage in expansion states and increased private insurance coverage in non-expansion states.

Between expansion and non-expansion states, the researchers found no significant difference in the likelihood that this population would receive cancer treatment. The authors did note, however, that the percentage of patients with HIV and cancer who were treated at academic facilities increased significantly in expansion states, from 40.2% to 46.7%.

Patients with HIV also have poorer cancer survival rates than patients without HIV, according to the National Cancer Institute. This could be attributed to a more advanced cancer at diagnosis, delays in treatment, or poorer access to appropriate treatments.

The researchers concluded that although implementation of the ACA was associated with improved insurance coverage among patients diagnosed with both HIV and cancer, lack of insurance is still a common barrier in non-Medicaid expansion states. The higher rates of patients with minority or low socioeconomic status living in non-expansion states highlights the need for increased insurance expansion, they said.

REFERENCES
  1. Corrigan, K, Nogueria K, Yabroff R, Lin C, et al. The impact of the Affordable Care Act on insurance coverage and cancer-directed treatment in HIV-infected cancer patients in the US. CANCER; Published Online Nov. 11, 2019. http://doi.wiley.com/10.1002/cncr.32563. doi:10.1002/cncr.32563.
  2. National Cancer Institute (NIH). HIV Infection and Cancer Risk. NIH website. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hiv-fact-sheet. Accessed Nov. 12, 2019.