CROI 2018 Abstract eBook
Abstract eBook
Poster Abstracts
African studies. However, incidence rates are much lower, probably reflecting the poorer access to cancer diagnosis in this province. The South African HIV Cancer Match Study will allow to identify disadvantaged populations in need of targeted interventions, a step towards Precision Public Health.
652 CANCER STAGE, TREATMENT, AND SURVIVAL COMPARING HIV CLINIC ENROLLEES AND SEER Keri Calkins , Geetanjali Chander, Corinne Joshu, Anthony T. Fojo, Richard D. Moore, Bryan Lau The Johns Hopkins University, Baltimore, MD, USA Background: The effect of HIV on cancer stage, treatment, and survival is unclear and differences may be driven by immune suppression and/or access to care. We compared cancer outcomes among people with HIV (PWH) enrolled in care to the general US population, with a sub-analysis stratified by CD4 count. Methods: We compared cancer stage at diagnosis, receipt of any cancer treatment, and restricted mean survival time (RMST) between 255 cancer cases in PWH enrolled in the Johns Hopkins HIV Clinical Cohort (JHHCC) and similar cases sampled from the NCI’s Surveillance, Epidemiology and End Results Program (SEER), presumed to be largely HIV negative. We performed G-computation using random forest methods to estimate the effect of HIV on stage and treatment risk differences (RD) and on RMST differences, adjusting for demographic and cancer covariates. We also stratified the JHHCC by CD4 cell count ≤200 and >200 cells/mm 3 , to examine effect modification by immune status at cancer diagnosis. Results: The probability of localized cancer was 0.30 among PWH in JHHCC, while it was 0.07 in SEER (Risk difference (RD)= 0.24 [95% CI= 0.17, 0.31]). Similarly, the probability of distant cancer was 0.45 in JHHCC versus 0.07 in SEER (RD=0.38 [95% CI= 0.31, 0.43]). Among those in JHHCC with ≤CD4 200, 74% received any cancer treatment compared to 80% of SEER (RD=-0.06 [95% CI= -0.24, -0.02]), but there was no difference in cancer treatment overall or at higher CD4 levels. Table 1 provides a comparison of mortality after cancer diagnosis between JHHCC and SEER. Model 1 accounted for age, sex, race, year of diagnosis, and cancer type; while model 2 also adds CD4 count at cancer diagnosis. PWH had evidence of reduced survival of all cancers after adjusting for the model 1 covariates (RMST Difference= -3.4 months [95% CI= -7.1, -0.2]). The observed difference was larger when examining PWH with CD4 ≤200 adjusting for the model 2 covariates (-10.6 months [95% CI=-18.3, -4.9]). Differences in survival were no longer significant when stage and treatment were added to the models. Conclusion: PWH are more likely to be diagnosed with cancer at earlier and later stages than the general US population, suggesting that HIV may contribute to faster progression and that engagement in HIV care may improve earlier detection. Survival differences were largely explained by cancer stage and treatment, although there is some evidence of lower rates of cancer treatment and higher mortality in those with low CD4 counts.
651 STILL HIGH RISK OF VIRUS-RELATED CANCER DESPITE 20 YEARS OF cART IN ICONA COHORT Pierluca Piselli 1 , Diego Serraino 2 , Alessandra Bandera 3 , Andrea Antinori 1 , Enrico Girardi 1 , Claudia Cimaglia 1 , Alessandro Tavelli 4 , Francesca Bai 5 , Gianmaria Baldin 6 , Andrea Calcagno 7 , Antonella D’Arminio Monforte 5 , Antonella Cingolani 6 1 Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy, 2 CRO Aviano National Cancer Institute, Aviano, Italy, 3 San Gerardo Hospital, Monza, Italy, 4 Icona Foundation, Milan, Italy, 5 University of Milan, Milan, Italy, 6 Catholic University of the Sacred Heart, Rome, Italy, 7 University of Turin, Turin, Italy Background: The advent of combination antiretroviral therapy (cART) in 1996, led to a decreased incidence of several cancers, in particular AIDS-defining malignancies (ADMs, i.e. Kaposi sarcoma-KS, Non-Hodgkin lymphoma-NHL and Invasive Cervical Cancer-ICC), and among non-AIDS defining malignancies (NADMs) of virus-related e.g. Hodgkin’s lymphoma (HL) or anal cancer. In our study, we quantified the incidence of cancer in a Large Italian cohort of ART-naïve persons with HIV or AIDS (PWHAs) HIV-diagnosed in the last 20 years (ICONA cohort). Methods: Person years (PY) at risk of cancer in the ICONA cohort (1996-2016) were computed from 30 days after first HIV-diagnosis to cancer diagnosis, death, drop out or last follow-up. The risk of cancer was assessed through sex- and age-standardized incidence ratios (SIR) computed by dividing the observed cases with expected ones from Italian cancer registries. Age- and sex-standardized incidence rates (ASR) were computed using the entire cohort as reference population and stratified for calendar periods. Results: Among 11761 PWHAs (77%males) during 69,221 PYs (median follow-up 4.8 years) with a median time at diagnosis of 2.3 years, 432 single new cancers were diagnosed in 421 enrolled individuals (3.6%), with overall incidence of 6.1 cases/103 PYs. ADMs represent most cancers (N=221, 51.2%), with a median time at cancer diagnosis of 0.9 years (4.2 among NADMs). Overall, significantly increased SIRs were observed for ADMs (SIR=18.4), and for virus- related NADMs (SIR=4.27), and overall for all virus-related cancers (SIR=11.0), but not for virus unrelated NADMs. (Fig.1 left panel). A reduced ASR over time was observed for KS and ICC from the first period (p<0.001) then remaining stable, but not for NHL, while a trend to an increasing incidence for virus-related NADMs was found in the first decade. ASR for virus unrelated NADMs remained overall stable [Fig.1 (right panels)]. Conclusion: A substantial higher incidence of cancer compared to general population was observed. Despite a decline over time for ADMs, risk of virus-related cancers remains elevated in the modern treatment era, possibly due either to sexual transmission of the causative virus or to persistent inflammation/immune activation. For not virus related cancers the incidence was comparable to that of general population and may represent an ageing effect, strongly suggesting additional efforts aimed at cancer prevention and screening among PWHAs.
Poster Abstracts
CROI 2018 242
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