CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

602 CANCER BURDEN AMONG HIV+ INDIVIDUALS ON ART IN MALAWI: A RECORD LINKAGE STUDY

Marie-Josephe Horner 1 , Steady Chasimpha 2 , Adrian Spoerri 3 , Julia Bohlius 3 , Hannock Tweya 4 , Eddie Moffo Phiri 5 , Sam Phiri 6 , Kennedy Malisita 5 , Charles Dzamalala 2 , Satish Gopal 7 1 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 Malawi Cancer Registry, Blantyre, Malawi, 3 Univ of Bern, Bern, Switzerland, 4 Lighthouse Trust Clinic, Lilongwe, Malawi, 5 Queen Elizabeth Hosp ART Clinic, Blantyre, Malawi, 6 Lighthouse Trust, Lilongwe, Malawi, 7 Univ of North Carolina Proj–Malawi, Lilongwe, Malawi Background: With improved antiretroviral therapy (ART) access in Africa, epidemiologic data are needed to characterize evolving cancer burden in contemporary HIV+ populations. In Malawi, HIV prevalence is 11% and estimated ART coverage 67%. The Malawi HIV-Cancer Match Study aims to characterize incidence and timing of cancer among new ART users. Methods: We used probabilistic record linkage to link cancer cases from the population-based national cancer registry with electronic medical records supporting ART delivery within the country’s two largest HIV cohorts. The study period includes years of overlap between the national cancer registry and HIV cohorts from Lighthouse Trust in Lilongwe (2007-2010) and Queen Elizabeth Hospital in Blantyre (2000-2010). Poisson regression was used to estimate cancer incidence rates (IR) and incidence rate ratios (IRR) among naïve ART initiators, stratified by sex, age at ART start (<30, 30-40, ≥40 years), and CD4 count at ART start (<50, 50-250, ≥250 cells/μL). Results: Preliminary results from Lighthouse Trust included 15,920 naïve ART initiators, with 57.8%women, mean age 34.4 years (SD 10.8), and median CD4 cell count of 47 cells/ μL (IQR 14-173) at start of therapy. Among reasons for ART initiation, 56.6% patients started due to a WHO stage III/IV condition, and 41.1% due to CD4 <250 cells/μL, the Malawi treatment threshold during the study period. Of 3,499 cancers; 82.2%were prevalent at HIV cohort enrollment, and 624 incident cancers occurred subsequently over 53,115 person- years at risk after enrollment. The overall IR was 1199 per 100,000 person-years (95%CI: 1109, 1296). Kaposi sarcoma (KS) was by far the commonest cancer (93.5%), followed by cervical cancer (4.1%). Non-AIDS defining cancers represent an emerging burden (Figure). The overall rate of cancer was higher among patients with CD4 ≥250 compared to <50 cells/μL (IRR 19.6, 95%CI 15.5, 24.7), but did not significantly differ by sex or age. Conclusion: Despite likely underascertainment, cancer burden remains high among ART users in Malawi, and is a common reason for entry into HIV care. Paradoxically, we found increased cancer risk among patients with higher CD4, perhaps due to reductions in competing risks. This suggests increasing cancer burden as earlier application of ART continues in Malawi and HIV+ populations age. Integrated KS and cervical cancer management within ART programs remains a critical component of HIV care in Malawi in the current era.

CROI 2017 255