CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Conclusion: Risks of ADC, some VRNADC, and lung cancer have decreased over time but remain elevated in the most recent years. Risk is also elevated for some rare cancers but not for several common cancers. Further research is needed to determine the contributions of changes in demographic characteristics (e.g., aging), cancer risk factors, and improving effectiveness and wider use of ART to these SIR trends. Although SIRs did not increase for any cancer site over time, it is important to continue monitoring cancer risk in HIV-infected people.

Poster and Themed Discussion Abstracts

601 CANCER INCIDENCE AMONG PERSONS ON MODERN SUPPRESSIVE ART, 2000–2012

Ann N. Burchell 1 , Kate Salters 2 , Oghenowede Eyawo 3 , Joanne Lindsay 4 , Jason Chia 5 , Michelle Cotterchio 6 , Mark Hull 3 , Monica Ye 7 , Janet M. Raboud 1 , Robert S. Hogg 1 1 St. Michael’s Hosp, Toronto, Ontario, Canada, 2 Simon Fraser Univ, Vancouver, British Columbia, Canada, 3 BC Cntr for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, 4 St. Michael’s Hosp, Toronto, Canada, 5 Cancer Care Ontario, Toronto, Canada, 6 Univ of Toronto, Toronto, Ontario, Canada Background: International studies suggest that the incidence of some cancers is rising among people with HIV (PLHIV) due to longevity gains from combination antiretroviral therapy (cART) and longer exposures to carcinogens. We sought to quantify excess cancer risk among PLHIV who initiated modern cART in a setting with free and universal access to cART. We hypothesized that AIDS-defining malignancies (ADMs) decreased while non-AIDS-defining malignancies (NADMs) increased over time, most notably for cancers with established infectious causes. Methods: We conducted a population-based cohort study of adults (≥ 19 years) living with and without HIV via record linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC in British Columbia (BC), Canada. The comparison sample of HIV-negative individuals was generated from a 10% random sample of the total BC population. For PLHIV, we included only those who initiated cART in 2000 and later. Incident primary cancer diagnoses were ascertained using ICD-O codes from 2000 to 2012 via record linkage with the BC Cancer Agency registry. Cancers were classified as: ADMs (Kaposi sarcoma; non-Hodgkin lymphoma; cervical cancer) vs NADMs (all others); and infectious (Kaposi’s sarcoma, non-Hodgkin’s lymphoma, cervical, anal, other genital, oropharyngeal, liver, stomach, and Hodgkin’s lymphoma) vs non-infectious (all others). Using the 1991 Canadian population as the standard, we report age-adjusted incidence rates (aIR) per 1,000 person-years (PY) with 95% confidence intervals [CI] and incidence rate ratios (aIRR) comparing rates between PLHIV and HIV-negative individuals. Results: A total of 4,320 PLHIV and 480,127 HIV-negative individuals were followed for 21,077 PY and 4,372,011 PY, respectively. New cancers were diagnosed among 195 HIV-positive and 21,538 HIV-negative residents. Combining all cancers across all years, there was 190% excess cancer among PLHIV (aIRR=2.9 [2.3, 3.4]). However, this varied by calendar period and cancer classification (Table). Conclusion: Our findings confirm higher risk for ADMs and cancers with infectious causes among people with HIV, even among those who initiated modern suppressive ARV therapy and had few economic barriers to its access. Although rates declined over time, by 2008-12, ADMs remained 10 times more common and infectious cancers were 8 times more common, respectively, than in the general population.

CROI 2017 254