Impact of Insurance Status on Outcomes in Individuals with AIDS-Defining Cancers

This single-center, retrospective cohort study evaluates whether insurance coverage and Ryan White HIV/AIDS Program assistance are associated with differences in treatment and survival outcomes in Kaposi sarcoma and aggressive non-Hodgkin lymphoma among people with HIV (PWH). Participants were classified as having private, Medicare, Medicaid, or no insurance. Hazard ratios (HRs) for progression and death were estimated using Cox proportional hazards regression models. Propensity score weighting was used to adjust for imbalances in age, ethnicity, and performance status. Among 191 participants, 18% had private insurance, 14% had Medicare, 46% had Medicaid, and 23% were uninsured. Forty-four percent received Ryan White assistance. Participants with Medicare and those without Ryan White assistance were older. Those without Ryan White assistance also had worse performance status. No differences in CD4⁺ T cell counts, HIV viral loads, highly active antiretroviral therapy adherence, time to treatment, and regimen selection were detected. After adjustment with propensity score weighting, participants without Ryan White assistance had a greater risk of death [adjusted HR 4.06, 95% confidence interval (CI) 1.45-11.41, p = .008] and progression (adjusted HR 3.39, 95% CI 1.43-8.05, p = .006) than those with Ryan White assistance. We conclude that among people with AIDS-defining cancers, those with Medicare and those without Ryan White assistance had higher mortality, possibly due to age and other medical comorbidities. Notably, underinsured PWH who received Ryan White assistance experienced similar outcomes as those with private insurance.