CROI 2025 Abstract eBook

Abstract eBook

Oral Abstracts

125

Differences in Treatment and Overall Survival in People With and Without HIV and Oropharynx Cancer Elizabeth Chiao 1 , Christine M. Hartman 2 , Devesh Malgave 3 , Jennifer R. Kramer 2 , Adovich S. Rivera 4 , Wendy Leyden 5 , Katherine Pak 4 , Peter A. Richardson 2 , Efthalia Zafeiropoulou 2 , Yongquan Dong 2 , Rulin C. Hechter 4 , Donna L. White 2 , Angela Mazul 6 , Lori C. Sakoda 5 , Michael Silverberg 5 1 University of Texas MD Anderson Cancer Center, Houston, TX, USA, 2 Michael E DeBakey VA Medical Center, Houston, TX, USA, 3 University of Texas Health Science Center at Houston, Houston, TX, USA, 4 Kaiser Permanente Southern California, Pasadena, CA, USA, 5 Kaiser Permanente Northern California, Oakland, CA, USA, 6 University of Pittsburgh, Pittsburgh, PA, USA Background: People with HIV (PWH) are at increased risk of oropharynx cancer (OPC) compared with people without HIV (PWoH). PWH and OPC also have poorer survival compared to PWoH and OPC. However, prior studies have not evaluated OPC treatment initiation and survival among cohorts of PWH and PWoH matched on demographic variables, stage, and HPV tumor status. Methods: We conducted a matched retrospective cohort study of PWH and PWoH diagnosed with OPC between 2008-2019 utilizing data from the Veterans Affairs and Kaiser Permanente health systems. PWH and PWoH with OPC were matched 1:1 on sex, age (+ 1 year), race, year of OPC diagnosis (+ 1 year), stage, and HPV status. Patients were followed from OPC diagnosis until death, loss-to-follow-up, or December, 31, 2021. Treatment initiation (chemotherapy, radiation, or surgery) within 180 days, and HPV tumor status were assessed through chart review. Kaplan-Meier curves by HIV and HPV status were conducted. Cox regression was used to assess the association of HIV infection with overall survival adjusting for matching variables, co-morbidity score, alcohol and tobacco use, and time-dependent chemotherapy and radiation initiation within 180 days of diagnosis. Results: Our analysis included 130 PWH and 130 PWoH OPC patients. There were no significant differences between PWH and PWoH on matched variables. Overall median age at OPC diagnosis was 57.8 years; 32.3% were non-Hispanic Black, 59% were non-Hispanic White, and 9% were Hispanic. The cohort included 20% diagnosed at stage 1 or 2, and 79.6% were stage 3 or 4a/b; 61.5 % were HPV positive. There was no significant difference in smoking history (82% vs 79% among PWH and PWoH, respectively). PWH and PWoH had comparable rates of chemotherapy and radiation uptake within 180 days (65.2% vs 72%, p= 0.166) and median time to treatment initiation (57 days vs 60 days, p=0.76). PWH had shorter restricted Mean Survival Time to PWoH (3.4 vs 3.9 years, p=0.04); HPV status was the largest predictor of survival regardless of HPV status (figure 1). In adjusted multivariable Cox survival analyses, HIV infection was associated with non-significant increase in mortality (HR 1.48, 95%CI: 1.00 to 2.28, p=0.063). Conclusions: In a matched cohort of PWH and PWoH with OPC, the two groups had similar treatment rates and timing of treatment initiation. When adjusted for receipt of treatment, there was a trend for poorer survival among PWH compared to PWoH.

126

Comparing Empirical HIV Incidence With UNAIDS Estimated Incidence Declines in Sub-Saharan Africa Oliver Stevens 1 , Elphas Okango 2 , Collins Iwuji 3 , Richard Hayes 4 , Daniel Kwaro 5 , Victor Ssempijja 6 , Louisa Moorhouse 1 , Sikhulile Moyo 7 , Ivan Kasamba 8 , Maya Petersen 9 , Sian Floyd 4 , M. Kate Grabowski 10 , Jeffrey Eaton 11 1 Imperial College London, London, UK, 2 Africa Health Research Institute, Mtubatuba, South Africa, 3 Brighton and Sussex Medical School, Brighton, UK, 4 London School of Hygiene & Tropical Medicine, London, UK, 5 KEMRI CGHR, Kisumu, Kenya, 6 Rakai Health Sciences Program, Kalisizo, Uganda, 7 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 8 Uganda Virus Research Institute, Entebbe, Uganda, 9 University of California Berkeley, Berkeley, CA, USA, 10 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 11 Harvard TH Chan School of Public Health, Boston, MA, USA Background: UNAIDS estimates, derived by fitting mathematical models to national surveillance data, indicate that HIV incidence in sub-Saharan Africa has declined substantially since 2000. We assessed whether the level and age distribution of HIV incidence from mathematical-model derived estimates, which are critical to guide epidemic response strategies, are consistent with empirical HIV incidence observations. Methods: We matched empirical HIV incidence observations from cohort studies, control arms of intervention trials, and Population-Based HIV Impact Assessment household surveys in sub-Saharan Africa conducted 1990-2022 to UNAIDS HIV incidence estimates by study area, gender, age group, and year. Using two Bayesian mixed-effect Poisson regression models we estimated (1) incidence rate ratios (IRR) between all empirical observations and matched modelled incidence estimates with covariates for gender, year, and study type/population; and (2) temporal patterns in age-specific incidence from population-based cohort studies alone. Results: Incidence data were included from 3479 observations from 148 studies conducted in 21 countries, comprising 20,000 infections and 2.3 million person years. Across population cohorts in South Africa, Uganda, Zimbabwe, and Kenya, HIV incidence among adults aged 15-49 declined by 75-90% between 2010 2023, and declined 3% (95%CI 2-4%) faster per year among young adults 15-24 compared to age 25+ years. Modelled incidence declined similarly to cohort data, but did not reflect the different rates of decline by age group. Relative to matched modelled estimates, incidence observations from representative household surveys (IRR 1.15 95%CI 0.86, 1.54) and population-based cohorts/Universal Testing and Treatment trials (IRR 0.91 95%CI 0.52-1.60) were not significantly different. Studies among pregnant women (IRR 2.83 95%CI 1.56, 5.13) and control arms of intervention trials (IRR 2.54 95%CI 1.64, 3.96) had significantly higher incidence than modelled incidence estimates. Conclusions: Incidence from modelled estimates were consistent for level and trend with population-representative studies, but significantly lower than studies with non-representative inclusion criteria, including those among pregnant women and most HIV prevention/vaccine efficacy trials. Incidence has declined steeply among population cohort studies and modelled estimates. The age pattern of incidence in modelled estimates should be revised to capture the aging of the epidemic indicated by cohort studies.

Oral Abstracts

26

CROI 2025