CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

in infection, inflammation signaling pathways, immune response activation, and cancer-related pathways, including NF-KB, PD-L1, and B-cells. Conclusion: Our study revealed a specific inflammatory signature predicting NAEs risk, with distinct inflammatory proteins strongly associated with the onset of non-AIDS cancers. These proteins warrant further exploration as promising biomarkers for SNAEs and as potential therapeutic targets.

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Prevalence of Cancer Screening in People With HIV Utilizing a Symphony Health Data Linkage in Texas Jennifer K McGee-Avila 1 , Eric Engels 1 , Cameron B. Haas 2 , Qianlai Luo 1 , Marie Josephe Horner 2 , Meredith Shiels 1 1 National Cancer Institute, Rockville, MD, USA, 2 National Cancer Institute, Bethesda, MD, USA Background: Cancer risk is elevated in people with HIV (PWH) compared to those without HIV. Screening for cancer can identify cancer at earlier stages where curative therapy can be most efficacious, or, in the case of cervical and colorectal cancers, identify precancerous lesions that can be treated, preventing progression to malignant cancer. For PWH, cancer screening is important given higher incidence of late-stage disease at diagnosis, disparities in receipt of cancer treatment, and elevated risk of cancer related mortality. Methods: Data from the HIV/AIDS Cancer Match (HACM) Study, a population based HIV and cancer registry linkage was linked to Symphony Health, an aggregator of health data including claims from medical, laboratory, hospital, and physician records, in Texas during 2008-2015. Among PWH, we estimated the prevalence of anal, breast, cervical, colorectal, and prostate screening using International Classification of Diseases, Ninth and Tenth Revision (ICD-9/10) diagnosis codes, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) codes, and revenue codes. For each screening type we limited the cohort to those who were screening eligible based on age criteria as of 2008, and then estimated ever screening during 2008-15. Results: We included a total of 51,610 people with HIV with linked claims data. Approximately 77.6% of PWH were male, and racial/ethnic breakdown was 39.8% Non-Hispanic (NH) Black, 36.6% NH White, 21.9% Hispanic, and 1.8% Other/Unknown. For age distribution, 16.8% was aged 18-29, 24.6% aged 30-39, 35.7% aged 40-49, 18.0% aged 50-59, 4.3% aged 60-69 and 0.6% aged 70-80. For women with HIV aged 30 and older, 38.5% received cervical cancer screening and similarly, 40.0% had ever received screening for breast cancer, between the ages of 40-74 during the observation period. Approximately 31.5% of men with HIV, between the ages of 55-69 received prostate cancer screening. For PWH between the ages of 45-75, approximately 26.7% received screening for colorectal cancer. Lastly, while official guidelines do not exist for the general population, among PWH between the ages of 35-70, only 0.96% received screening for anal cancer. Conclusion: Findings suggest utilization of screening modalities for anal, breast, cervical, colorectal, and prostate cancer are underutilized among PWH in Texas. More work is needed to determine barriers to receiving screening. Racial Disparities in Cancer Incidence Among Men Who Have Sex With Men With HIV in the US, 2001-2019 Benton G Meldrum 1 , Meredith Shiels 1 , Jennifer K. McGee-Avila 1 , Tyler Adamson 2 , Qianlai Luo 1 , Tabassum Insaf 3 , Ruth Pfeiffer 1 , Eric Engels 1 , Cameron B. Haas 1 1 National Cancer Institute, Rockville, MD, USA, 2 Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA, 3 New York State Department of Health, Albany, NY, USA Background: Men who have sex with men (MSM) are disproportionately affected by HIV, representing 68% of new diagnoses in 2019. Racial inequities in access to HIV screening, diagnosis, and treatment result in lower prevalence of viral suppression for non-white MSM. We hypothesize that higher risk of progression to AIDS is likely to increase cancer risk among non-white MSM with HIV (MSMWH). Methods: We investigated racial disparities in cancer risk among MSMWH from 2001-2019 using the HIV/AIDS Cancer Match Study data. We examined 9 cancer types: prostate, lung, liver, anal, non-Hodgkin lymphoma, oropharyngeal,

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Starting ART Early After HIV Acquisition Reduces Long-Term Non-AIDS Defining Malignancy Risk Iris A van der Wulp 1 , Ferdinand Wit 2 , Peter Reiss 3 , Marc Van der Valk 2 1 Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands, 2 Stichting HIV Monitoring, Amsterdam, Netherlands, 3 University of Amsterdam, Amsterdam, Netherlands Background: Non-AIDS Defining Malignancies (NADM) have become a prominent cause of death in people with HIV (PWH). Evidence shows that starting antiretroviral treatment (ART) at a higher CD4 count is associated with reduced NADM risk. We aimed to investigate whether starting ART early after acquiring HIV reduces NADM risk even further. Methods: We included PWH 18 years or older from the Dutch National ATHENA cohort without a known NADM diagnosis starting ART between 1/1/2000– 31/12/2022. NADM and infection-related NADM were analyzed separately. Individuals who started ART ≤365 days of a last known negative HIV test or with a documented primary infection (Fiebig stages 1-5) were categorized as "Early ART", and all others as "Late-ART" starters. Hazard Ratios (HR) for NADM were estimated by unadjusted and adjusted Cox regression. Models were adjusted for traditional (age, sex at birth, calendar time, HIV transmission category, smoking (time-updated), and region of origin) and HIV related (time-updated CD4 count lagged by 3 months, CD4/8 ratio and time spent with HIV RNA >1000 copies/ ml) factors. Results: Early-ART compared to Late-ART starters were younger (median age 34.7 vs. 39.4 years), more often male (94.3 vs. 80.0%), with a CD4 count >500 cells/mm 3 at ART start (42.6 vs. 18.8%), less often current or former smokers (39.7 vs. 44.9%), and had shorter median follow-up (68 vs. 115 months). In the Early-ART starters (n=2,036) 28 NADM occurred during 12,454 PYFU (IR 2.2/1000 PYFU) versus 1,160 NADM during 220,237 PYFU (IR 5.3/1000 PYFU) in Late-ART starters (n=22,183). Unadjusted, Early-ART start was associated with a significantly reduced NADM hazard (HR 0.48 [95% Confidence Interval (CI) 0.33– 0.69]), which was only moderately attenuated after adjustment (multivariate HR 0.63 [95% CI 0.43–0.92]). When only considering infection-related NADM, 8 events occurred in Early-ART starters (n=2,037) during 12,531 PYFU (0.6/1000 PYFU) versus 378 during 223,390 PYFU (IR 1.7/1000 PYFU) in Late-ART starters (n=22,252). Early-ART start was associated with a significantly lower infection related NADM hazard (HR 0.38 [95% CI 0.19–0.78]) in unadjusted analysis. In our multivariable model results were similar to the all-NADM analysis, but lacked statistical significance (HR 0.64 [95% CI 0.31–1.29]). Conclusion: Starting ART within a year of acquiring HIV or during primary infection reduces the risk of NADM compared to starting ART later after infection. Larger studies should assess the impact on individual NADM types.

Poster Abstracts

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