CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

1 Yale University, New Haven, CT, USA, 2 Massachusetts General Hospital, Boston, MA, USA Background: Non-small cell lung cancer (NSCLC) is the most common non-AIDS defining cancer among people living with HIV (PLWH) and is associated with increased mortality. This study used quantitative immunofluorescence (QIF) to evaluate differences in the NSCLC tumor microenvironment between HIV+ and HIV- patients. Methods: Paraffin-embedded tumor tissue from patients with NSCLC at Yale New Haven Hospital between 2001-2016 were retrieved. 18 HIV+ cases and 19 HIV- controls (matched for age, sex, histologic subtype, cancer stage, and year of cancer diagnosis). Clinical grade chromogenic assay was used to calculate whether the tumor expressed PDL1 (> 5% cut-off for positivity). In addition, QIF was used to measure expression of PDL1, CD4, CD8, and CD20 both within the tumor and surrounding stroma. Early stage cancer was defined as Stages I-II while late stage was defined as Stages III-IV. t-tests and chi-square tests were used to compare continuous and categorical variables, respectively. Results: Median age was 53 and 59 among HIV+ and HIV- patients. Median CD4 count and viral load among HIV+ were 440 cells/μL and 78 copies/ml respectively, with 77% of patients on ART at time of NSCLC diagnosis. No difference in mortality was observed in early stage NSCLC between HIV+ and HIV- groups [HR 1.59 (95% CI 0.36-7.04)]. However, among late stage NSCLC, HIV+ patients had higher mortality rate [HR 5.52 (95% CI 1.87-16.46)]. Tumor cells from 44% of HIV+ compared to 21% of HIV- patients were positive for PDL1 by chromogenic assay (p= 0.14). QIF analysis revealed no statistical differences in CD4 or CD8 infiltrate between HIV+ and HIV- tissues. Cox regression analysis found higher intra-tumor CD20 expression was associated with improved survival [HR 0.775 (95% CI 0.614-0.978)]. This effect was greater in HIV- (HR 0.603) compared with HIV+ cases (HR 0.894), though this difference did not reach statistical significance (p = 0.18). Conclusion: After controlling for age, date of diagnosis, histology, and stage in a well-matched cohort of NSCLC, we found that PLWH have a worse prognosis with late stage NSCLC. Tumors from HIV+ patients are more likely to express PDL1 compared to HIV- cases. High CD20 signal was associated with improved survival in NSCLC and HIV status may be a moderator of this interaction. Further characterization of specific T cell inhibitory and regulatory pathways within the tumor immune microenvironment is critical to understand how immune dysfunction in HIV impacts outcomes of disease. 292 BURKITT LYMPHOMA IN THE ART ERA: STABLE INCIDENCE AND POOR SURVIVAL Eva Clark , Kathryn E. Royse, Elaine Chang, Suchismita Raychaudhury, Jennifer Background: Despite advances in diagnosis and treatment of both HIV and Burkitt lymphoma (BL), persons living with HIV (PLWH) remain at high risk for BL. We conducted this study to determine if there have been any changes in risk or survival among patients with HIV and BL during the anti-retroviral era. Methods: HIV positive male veterans receiving care between 10/01/1999 and 12/31/2016 in the Veterans Administration Medical Center (VAMC) were retrospectively identified using electronic medical records (EMR). Incident BL diagnosis was identified through VA Cancer Registry review and ICD-9/10 codes. Patients with a minimum of 30 days between HIV and BL diagnosis or death, their last recorded health care encounter, or study end were included in the analysis. Demographic, lifestyle, and clinical variables were extracted from EMR for analysis. Hazard ratios (HR) and 95% confidence intervals (CI) for BL risk and survival were estimated in univariate (p<0.25) and multivariate (p<0.10) time- varying Cox proportional models. Results: We identified 46,778 HIV positive veterans, of whom 76 developed BL during follow-up (incidence rate [IR] = 2.79 per 100,000 person years, 95% CI: 2.23-3.49). The IR for HIV positive veterans did not decrease over the study period. Table 1 demonstrates results of a Cox proportional hazards model describing characteristics associated with BL diagnosis in HIV positive veterans. Median CD4 count at BL diagnosis was 274, (SD: 344.78) and was noted to increase over time (median CD4 for individuals diagnosed with BL before 1999 was 211 [SD: 195.78], 265 [SD: 354.95] for those diagnosed between 2000-2009, and 450 [SD: 516.89] for those diagnosed between 2010-2016). Survival was significantly decreased in HIV positive veterans with BL as compared to HIV negative controls (p<0.05). An undetectable viral load for at least 40% of the R. Kramer, Donna L. White, Elizabeth Chiao Baylor College of Medicine, Houston, TX, USA

290 CANCER INCIDENCE AMONG A COHORT OF PERSONS RECEIVING HIV CARE IN WASHINGTON, DC Amanda B. Spence 1 , Matthew E. Levy 2 , Anne K. Monroe 2 , Joseph Timpone 1 , Amanda D. Castel 2 , Michael A. Horberg 3 , Princy Kumar 1 , for the DC Cohort Executive Committee 1 Georgetown University, Washington, DC, USA, 2 George Washington University, Washington, DC, USA, 3 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA Background: The incidence of AIDS-related cancers (ADCs) has declined in this era of effective combination antiretroviral therapy with increases in certain non-AIDS related cancers (NADCs). We examined the incidence of ADCs and specific NADCs as well as eligibility for age-related cancer screening among persons living with HIV (PLWH) in the District of Columbia (DC). Methods: Participants actively enrolled in the DC Cohort, a longitudinal study of PLWH which enrolled patients starting in 2011, through 12/2017 were included. Cancer diagnoses were determined through ICD-9/10 coding, and incidence was calculated among patients at risk using total person-time at risk through the observation period. Eligibility for cancer screening was determined based on age, sex, smoking history, and co-morbidity data available through the cohort and IDSA, USPSTF, or AASLD guidelines. Results: Among 7912 participants, 72.4%were male, 77.8% black, and median age was 50 (IQR39-58) with 13.2 median years since HIV diagnosis. Fifty-six percent of participants had smoking history and 12.7% chronic Hepatitis C Virus (HCV). Median CD4+ count was 592 cells/mL(IQR 390-809.5) and 84.4% had HIV RNA <200 c/mL at most recent testing. In this cohort, cancer screening eligibility based on recommended guidelines was as follows: colorectal 4010 (51%), anal 3,301 (42%), breast 2144 (49.2%), and lung cancer 1250 (15.9%) with 264 (3.3%) eligible for hepatocellular carcinoma (HCC) screening. The incidence rate of NADCs was 12.1 (95% CI 10.7,13.8) and ADCs 1.6 (95% CI 0.6,4.6) per 1000 person-years. The most common incident NADCs were prostate 2.3 (95% CI 1.2,4.3), breast 2.6 (95% CI 0.5,12.1), skin 1.3 (95% CI 0.7,2.6), head/neck 1.1 (95% CI 0.7,1.9), anal 1.1 (95% CI 0.4,2.9), lung 1.0 (95% CI 0.5,1.9), and colorectal 0.9 (95% CI 0.4,1.9) incident diagnoses/cases per 1000 person-years. The incidence of ADCs were: non-Hodgkin’s lymphoma (NHL) 0.9 (95% CI 0.3,2.5), cervical cancer 0.7 (95% CI 0.1,4.4), and Kaposi sarcoma (KS) 0.5 (95% CI 0,7.1) diagnoses/cases per 1000 person-years. Conclusion: In this aging cohort of PLWH, there were more incident NADCs versus ADCs in contrast to older cohort studies where ADC predominated and reflective of newer data showing higher incident rates of NADCs. A large proportion of this cohort is eligible for age-related cancer screening for NADCs. Implementation of preventative measures and age-related cancer screening is an important component of care in this aging population. 291 HIGH CD20 LEVELS IN LUNG CANCER TISSUE FROM PLWH ASSOCIATED WITH IMPROVED SURVIVAL Ramsey Yusuf 1 , Franz Villarroel 1 , Kristen Hysell 2 , Fangyong Li 1 , Kurt Schalper 1 , Brinda Emu 1

Poster Abstracts

CROI 2019 106