Studies have reported lower incidence of prostate cancer in men living with HIV compared to men without HIV for reasons that remain unclear. Lower prostate cancer screening in men living with HIV could explain these findings. We describe receipt of prostate-specific antigen (PSA) test each calendar year by HIV status in Medicaid beneficiaries enrolled in 14 US states, 2001-2015. A total of 15,240,871 Medicaid beneficiaries aged 18-64 with ≥7 months of continuous enrollment were included in analyses. HIV diagnosis and PSA tests were identified using non-drug claims. Incidence rate ratios comparing receipt of PSA test by HIV status adjusted for age, race-ethnicity, state of residence, calendar year, comorbid conditions, benign prostatic conditions, and receipt of testosterone-replacement therapy were estimated using Poisson regression. Models were also stratified by state and estimates were pooled using random effects meta-analysis to account for heterogeneity by state. Models were additionally stratified by age and race-ethnicity. There were 42,503 PSA tests over 314,273 person-years and 1,669,835 PSA tests over 22,023,530 person-years observed in beneficiaries with and without HIV, respectively. Incidence of PSA test was slightly lower in men living with HIV than men without HIV (IRR=0.98; 95% CI: 0.97, 0.99) when adjusting for state. In the pooled estimate, the rate was higher among men living with HIV (IRR=1.11; 95% CI: 0.97, 1.27). Pooled estimates indicated approximately equal or higher rates of PSA test in men living with HIV compared to men without HIV across models stratified by age and race-ethnicity groups. Findings do not support the hypothesis that differences in prostate cancer screening explain differences in incidence by HIV status.
AIDS research and human retroviruses. 2024 Jun 06 [Epub ahead of print]
Filip Pirsl, Keri Calkins, Jacqueline Rudolph, Eryka Wentz, Xiaoqiang Xu, Yiyi Zhou, Bryan Lau, Corinne Joshu
Johns Hopkins University Bloomberg School of Public Health, Epidemiology, Baltimore, Maryland, United States; ., Johns Hopkins University Bloomberg School of Public Health, Epidemiology, Baltimore, Maryland, United States., Johns Hopkins University Bloomberg School of Public Health, Epidemiology, Baltimore, Maryland, United States; ., Johns Hopkins University Bloomberg School of Public Health, Epidemiology, Baltimore, Maryland, United States; ., Johns Hopkins Unversity, School of Medicine, 550 N Broadway, Suit 209, Baltimore, Maryland, United States, 21205; ., Johns Hopkins University Bloomberg School of Public Health, Epidemiology, Baltimore, Maryland, United States; ., Johns Hopkins University Bloomberg School of Public Health, Epidemiology, Baltimore, Maryland, United States; ., Johns Hopkins University Bloomberg School of Public Health, Epidemiology, 615 N. Wolfe Street, Rm. E6148, Baltimore, Maryland, United States, 21205; .