CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Programs to prevent smoking initiation among adolescents and young adults at-risk for HIV could prevent up to 46% of NADC in HIV-infected adults. Using ART to preserve immune status, maintain HIV viral suppression, and prevent AIDS-defining illnesses could prevent up to 6% of NADC in HIV-infected adults. In order to reduce the NADC burden in HIV-infected adults, effective interventions to reduce smoking are needed with a continued focus on HIV treatment. 727 High Frequency of Early Lung Cancer Diagnosis With Chest CT in HIV-Infected Smokers Alain Makinson 1 ; Sabrina Eymard-Duvernay 2 ; François Raffi 3 ; Fabrice Bonnet 4 ; LaurenceThirard 5 ; PierreTattevin 6 ; Sophie Abgrall 7 ; Jacques Reynes 1 ;Vincent Le Moing 1 on behalf of the ANRS EP48 HIV CHEST StudyTeam 1 University Hospital Montpellier, UMI233, Montpellier, France; 2 UMI 233, IRD, University Montpellier 1, Montpellier, France; 3 Nantes University Hospital, Nantes, France; 4 University Hospital Bordeaux, Inserm U897, Bordeaux, France; 5 Tourcoing University Hospital, Tourcoing, France; 6 Pontchaillou University Hospital, Rennes, France; 7 University Hospital Avicennes, Bobigny, France; 8 ANRS, Paris, France Background: The National Lung Screening Trial has provided compelling evidence of the efficacy of lung cancer screening using chest low-dose computed tomography (LDCT) to reduce lung cancer mortality, but further studies are needed to evaluate LDCT screening in different populations. We sought to study the feasibility and to identify specificities of early lung cancer diagnosis with LDCT in HIV-infected smokers. Methods: The ANRS EP48 HIV CHEST study is a French, multicentre, prospective study consisting of a one round, millimetric, chest LDCT of HIV-infected subjects ≥ 40 years with a history of cumulative smoking within the last 3 years ≥ 20 pack-years, a CD4 T-lymphocyte nadir cell count < 350/ m l, and a last CD4-T cell count > 100 cells/ m l. A significant nodule on baseline CT, inducing CT follow up or immediate diagnostic procedures, was defined by a solid or partly solid nodule ≥ 5 mm or a non solid nodule ≥ 8 mm. Follow up and biopsy procedures were suggested in a workup algorithm, with a systematic follow-up of 2 years. Under the hypothesis of a 2.6 increased risk of lung cancer in HIV-infected smokers versus HIV-uninfected counterparts, we estimated lung cancer prevalence to be 3%. Hence, we aimed to enrol 445 patients, and expected 13 diagnosis of lung cancer [95% Confidence Interval, 7-22]. Results: Between March 2011 and June 2012, 442 subjects were enrolled. Median age was 49.8 years, (interquartile range (IQR) 46.3-53.9), 84%were men, median cumulative smoking was 30 pack-years (IQR 25-40), median last CD4 and nadir CD4 cell counts were 574/ m l (IQR 408-765) and 168/ m l (IQR 75-256) respectively, and 90% had a plasma HIV RNA < 50 copies/ml. A significant nodule was reported in 94 (21%) subjects on baseline CT. Lung cancer (5 staged IA) was diagnosed in 8 subjects (1.81 %), all but one in subjects aged < 55 years (table). There were no serious adverse events due to diagnostic procedures, and 29 subjects were lost to follow up.

M : Male; F: Female Conclusions: Early lung cancer diagnosis and nodule follow up with LDCT are feasible in HIV-infected smokers. Prevalence of lung cancer was within expected range and 5/8 cancers were surgically curable stage IA. The rate of significant nodules on baseline CT was not higher than the ranges published in non HIV-infected screening studies. Lung cancer screening of subjects between the ages of 55-74 years as recommended in the general population may miss substantial numbers of cancers in HIV-infected smokers with a nadir CD4 cell count < 350/ m l. 728 CD4 Measures as Predictors of Lung Cancer Risk and Prognosis in HIV Infection Keith Sigel 1 ; Kristina Crothers 2 ; Kirsha Gordon 3 ; Sheldon Brown 4 ; David Rimland 5 ; Maria Rodriguez-Barradas 6 ; Cynthia Gibert 7 ; Matthew B. Goetz 8 ; Roger Bedimo 9 ; Robert Dubrow 10 1 Icahn School of Medicine at Mount Sinai, New York, NY, US; 2 University of Washington School of Medicine, Seattle, WA, US; 3 VA Connecticut Healthcare System and Yale University Schools of Medicine and Public Health, New Haven, CT, US; 4 James J. Peters VA Medical Center, Bronx, NY, US; 5 Atlanta VA Medical Center, Atlanta, GA, US; 6 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, US; 7 Washington DC Veterans Affairs Medical Center, Washington, DC, US; 8 Los Angeles VA Medical Center, Los Angeles, CA, US; 9 Veterans Affairs North Texas Health Care System, Dallas, TX, US; 10 Yale University School of Public Health, New Haven, CT, US Background: Immunodeficiency may adversely affect both lung cancer risk and outcomes in the setting of HIV infection. Using data from a large HIV cohort, we investigated relationships between 1) recent and cumulative measures of CD4 and CD8 count and lung cancer incidence and 2) CD4 measures and lung cancer prognosis. Methods: We followed 26,065 HIV+ subjects from the Veterans Aging Cohort Study (VACS) for a minimum of 2 years, during 1999-2010. We linked VACS with the VA Central Cancer Registry to obtain incident, pathologically confirmed lung cancer cases. Our exposures of interest were longitudinal CD4 (<200 cells/mm 3 [c/mm 3 ], 200-500 c/mm 3 or >500 c/mm 3 ), CD4/CD8 (<0.4 or ≥ 0.4) and CD8 ( ≥ 850 c/mm 3 or <850 c/mm 3 ). We used Cox regression models to investigate the effect of time-updated CD4, CD4/CD8 ratio and CD8 measures on lung cancer risk, including values lagged 12 months, and 12- and 24-month simple moving averages. Models were adjusted for age, sex, race/ethnicity, smoking, and history of pneumonia and COPD. We then collected all non-small cell lung cancer cases from the full VACS (HIV+ and HIV- subjects from 1996-2010) and used conditional probability function regression (a competing risks method to account for higher risk of non-lung cancer death in HIV+) to compare lung cancer-specific survival in 3 groups: HIV- (n=679), HIV+ with CD4 ≥ 200 c/mm 3 at cancer diagnosis (n=299) and HIV+ with CD4<200 c/mm3 at cancer diagnosis (n=113). These analyses were adjusted for demographics, comorbidity score, cancer stage and histology, cancer diagnosis year, and cancer treatment. Results: We identified 325 (1.2%) cases of incident lung cancer in our cohort. In adjusted models (Table 1), a 12 month lagged CD4 count <200 c/mm 3 as well as moving averages of both CD4<200 c/mm 3 and CD4 200-500 c/mm 3 were significantly associated with increased lung cancer incidence. In similar adjusted models, 12-month moving averages of CD4/CD8 ratio <0.4 were also significantly associated with increased risk of lung cancer. Among lung cancer cases, lung cancer-specific survival did not differ between either of the HIV+ groups and the HIV- group (p>0.05) after adjustment.

Poster Abstracts

448

CROI 2015