CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

664 ABLATION OUTCOMES FOR HIV INFECTED AND UNINFECTED PATIENTS WITH ANAL DYSPLASIA Keith M. Sigel , Yuxin Liu, Michael Gaisa Icahn School of Medicine at Mt Sinai, New York, NY, USA Background: Human papilloma virus (HPV) associated high-grade intraepithelial lesions (HSIL) are the putative anal cancer (AC) precursors and are highly prevalent in HIV infected (HIV+) patients. Screening and local ablation of anal HSIL has been proposed for high-risk patients but is associated with substantial recurrence rates. Using data from a large AC screening cohort, we evaluated long-term outcomes following HSIL ablation. Methods: We identified 427 participants in our anal dysplasia screening programwith histologically confirmed HSIL who were treated with electrocautery ablation. Using high-resolution anoscopy, surveillance was conducted within 12 months to assess treatment response. HSIL identified in the same anatomic region of the anal canal as the previously ablated index lesion was defined as persistent, whereas new HSIL independent from the index lesion were defined as metachronous. We also defined overall recurrence as the presence of either persistent or newmetachronous lesions on follow-up. Baseline demographic information, sexual behaviors, smoking, HIV biomarkers, and number of HSIL were abstracted from a clinical database. Using unadjusted and multivariable analyses, we then examined frequency of outcomes and predictors of HSIL recurrence. Results: Our cohort largely consisted of men who have sex with men (93%) and 91% of subjects were HIV+. HSIL persistence after ablation was 39% (Table 1; 95% confidence interval [CI]: 34%-43%) and did not differ significantly by HIV status or sexual behavior. No invasive cancers were detected on follow- up. Metachronous HSIL at follow-up was found in 27% (95% CI: 23%-31%) of subjects. The combined outcome of persistent or metachronous HSIL (overall recurrence) occurred in 53% and was more frequent in HIV+ persons (56% vs. 28%; p=0.001). 194 (45%) subjects had more than one HSIL lesion on baseline examination; this group had a higher risk of HSIL persistence than those with solitary lesions (48% vs. 32%; p=0.001). No other factors were associated with risk of HSIL persistence, including age, race/ethnicity, smoking, and (among HIV+ subjects) baseline HIV viral suppression and CD4 count. HIV infection was associated (odds ratio 3.2; 95% CI: 1.5-6.9) with overall recurrence of HSIL after adjustment for baseline number of lesions. Conclusion: In our cohort, over a third of anal HSIL persisted after electrocautery ablation. HIV+ patients with multiple index lesions at baseline are at a higher risk of recurrence and may require careful surveillance. 665 PATTERNS OF REPEATED ANAL CYTOLOGY TESTING AMONG HIV-POSITIVE AND HIV-NEGATIVE MSM Hilary Robbins 1 , Dorothy J. Wiley 2 , Ken Ho 3 , Michael Plankey 4 , Susheel Reddy 5 , Nancy Joste 6 , Teresa Darragh 7 , Elizabeth Breen 2 , Stephen Young 6 , Gypsyamber D’Souza 1 1 Johns Hopkins Hospital, Baltimore, MD, USA, 2 University of California Los Angeles, Los Angeles, CA, USA, 3 University of Pittsburgh, Pittsburgh, PA, USA, 4 Georgetown University, Washington, DC, USA, 5 University of Chicago, Chicago, IL, USA, 6 University of NewMexico, Albuquerque, NM, USA, 7 University of California San Francisco, San Francisco, CA, USA Background: Men who have sex with men (MSM) are at increased risk for anal cancer, and this risk is further elevated among HIV-positive MSM. In cervical cancer screening, patterns of repeated cytology are used to identify low- and high-risk women, but little is known about these patterns for anal cytology among MSM. Methods: We analyzed data fromMSM in the Multicenter AIDS Cohort Study (MACS) who were offered anal cytology testing annually (HIV-positive, n=708) or every 2 years (HIV-negative, n=796) for 4 years. After excluding men with anal dysplasia treatment during testing, at least 2 valid cytology results were available for 474 HIV-negative and 502 HIV-positive MSM, and at least 3 results

for 328 HIV-positive MSM. We used inverse probability weighting to address possible selection bias. Results: Following a single negative cytology, the frequency of the next cytology remaining negative was lower among HIV-positive MSM with CD4≥500 (74%) or CD4<500 (68%) than HIV-negative MSM (83%) (p<0.001). Alternatively, after a single abnormal cytology, the frequency of the next cytology remaining abnormal was highest among HIV-positive MSMwith CD4<500 (70%) compared to CD4≥500 (53%) or HIV-negative MSM (46%) (p=0.003). Among HIV-positive MSM, 37-38% had 3 consecutive negative results, while the proportion with 3 consecutive abnormal results was larger among CD4<500 (22%) than CD4≥500 (10%) (p=0.008). Conclusion: Many HIV-positive MSM have consistently negative anal cytology over a four-year period. Following abnormal anal cytology, a repeated cytology is commonly negative in HIV-negative and HIV-positive MSM, although persistent cytological abnormality is more likely among HIV-positive MSM with CD4<500. Boris Revollo , Sebastia Videla, Arelly Ornelas, Roger Paredes, Josep Coll, Marta Piñol, Francesc García-Cuyás, Antoni Tarrats, David Parés, Ross Cranston, Bonaventura Clotet, Guillem Sirera Fundació Lluita Contra la Sida, Badalona, Spain Background: Anal cancer screening is key to detection and treatment of precancerous lesions in HIV-infected patients but its impact on survival is debated. We compared the incidence of invasive anal squamous cell carcinoma (IASCC) in HIV-infected patients included in a single-center anal cancer screening program (screening cohort) with that from subjects from the same center who where not included in the program (non-screening cohort). Methods: All subjects were HIV-1 infected adults from single tertiary care center in Catalonia, Spain, and all had at least 6 months of clinical follow up between January 2005 and December 2014. Subjects included in the screening program received an anal cytology every 6 to 12 months. High-resolution anoscopy and directed biopsy were performed for those with ASCUS, LSIL or HSIL anal cytology. AIN lesions on biopsy were treated. The incidence of IASCC was estimated and compared with that of subjects who declined to participate in the screening cohort but had followed at least 2 regular clinical visits during one year within the same study period. Results: 3343 subjects (1546 men who have sex with men (MSM), 914 men who have sex with women (MSW), 723 women, and 160 men with no data on sexual orientation) were included, 1916 of them (57%) followed the prospective anal cancer screening (median 4.4 person-years of follow-up) and the remaining 1427 (43%) did not (median 5.7 person-years of follow-up). Both cohorts were well balanced in terms of age, gender, duration of HIV-1 infection, time on antiretroviral therapy, CD4+ T-cell counts and HIV-1 RNA at the first study visit and nadir CD4+ T-cell counts. Subjects in the screening cohort were predominantly MSM (62.1%MSM, 14.7%MSW) whereas those in the non-screened cohort where predominantly MSW (25%MSM, 44.3%MSW) (p<0.001). Ten IASCC were diagnosed during the study follow-up: 2 (both MSM) in screening cohort and 8 (4 of them in MSM, 2 in women and another 2 in MSW) in non-screening cohort. The cumulative incidence was 0.01% (95%CI: 0.03- 0.4%) and 0.6% (95%CI: 0.3-1.1%) respectively, p-value: 0.023. The incidence rate was 0.02 per 100 person-years in the screening cohort and 0.09 per 100 person-years in non-screening cohort, p-value: 0.151. Conclusion: Engagement on an anal cancer-screening program is associated with lower incidence of IASCC. Women and MSWmight also benefit from such program. 667 ANAPLASTIC LARGE CELL LYMPHOMA IN HIV-INFECTED INDIVIDUALS Parag Mahale 1 , Dennis D. Weisenburger 2 , Amy R. Kahn 3 , Lou Gonsalves 4 , Karen Pawlish 5 , Lori Koch 6 , Mirabel Tirado-Gomez 7 , Christina A. Clarke 8 , Glenn Copeland 9 , Georgetta Alverson 9 , Meredith S. Shiels 1 , Eric A. Engels 1 1 NCI, Rockville, MD, USA, 2 City of Hope National Medical Center, Duarte, CA, USA, 3 New York State Department of Public Health, Albany, NY, USA, 4 Connecticut Department of Public Health, Hartford, CT, USA, 5 New Jersey Department of Health, Trenton, NJ, USA, 6 Illinois Department of Public Health, Springfield, IL, USA, 7 Puerto Rico Department of Health, San Juan, PR, USA, 8 GRAIL, Inc, Menlo Park, CA, USA, 9 Michigan Department of Health and Human Services, Lansing, MI, USA 666 EFFECTIVENESS OF A SCREENING PROGRAM FOR ANAL CANCER PREVENTION IN HIV-INF. PATIENTS

Poster Abstracts

CROI 2018 247