Multilevel disparities in HIV-associated gastrointestinal cancer mortality in the United States, 1999–2020.

e15688 Background: Although gastrointestinal (GI) cancers are more common in people living with HIV (PLWH), it is unclear how HIV-related mortality disparities differ by race, sex, age, and geography. Methods: From 1999 to 2020, we examined U.S. death certificate data from the CDC WONDER Multiple Cause of Death database. The esophagus, stomach, colon/rectum, anus, liver, and pancreas were among the GI cancers. ICD-10 codes B20–B24 were used to identify HIV. Rate ratios (RR) by race and cancer site were estimated using age-adjusted mortality rates (AAMR). Log-linear regression was used to calculate the annual percent change (APC) in mortality, stratified by race, sex, age group, and U.S. Census region. Results: HIV infection was linked to a significantly increased mortality rate from GI cancers, with substantial variation based on race. The most pronounced HIV-related excess was observed in esophageal cancer among American Indian/Alaska Native individuals (RR 1.56, 95% CI 1.17–2.07), surpassing the rate seen in White individuals (RR 1.08, 95% CI 1.05–1.10). Furthermore, Black PLWH exhibited heightened mortality rates for both esophageal (RR 1.16, 95% CI 1.08–1.24) and colorectal cancers (RR 1.08, 95% CI 1.04–1.13). Elevated mortality from liver cancer associated with HIV was evident across all racial groups.Notwithstanding these disparities, improvements were noted in several subgroups. Among Black Americans, the mortality rate from GI cancer decreased in PLWH (APC −1.97%/yr), while it increased in those without HIV (APC +2.06%/yr). This resulted in a −4.02% annual reduction in the disparity related to HIV. Analyses by sex showed a decrease in HIV-related mortality for both men (APC −1.94%/yr) and women (APC −0.88%/yr), whereas non-HIV GI cancer mortality increased in both groups. Age-specific trends revealed the most significant improvements in PLWH aged 50–59 (APC −3.12% to −2.87%/yr), while declines were slower in those aged 60–64. Regionally, the burden of HIV-associated GI cancer increased most rapidly in the U.S. South (APC +7.65%/yr), which was much greater than the non-HIV trend (+0.55%/yr). Conclusions: HIV infection is linked to significantly increased mortality from GI cancers, exhibiting notable disparities based on race, age, sex, and geographic region. Despite the observed decline in HIV-associated mortality across numerous subgroups within the contemporary antiretroviral treatment landscape, the burden is escalating rapidly in the Southern United States, and disparities persist among the American population. Indian/Alaska Native and Black populations highlight the need for targeted, region-specific HIV-oncology interventions.