CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: In longitudinal follow-up, there was a lower incidence of prostate cancer among PWH compared with matched controls but some suggestion of differences in grade and stage at diagnosis. Further study is warranted to understand the role of HIV status on prostate cancer treatment and outcome.

1072 PROSTATE CANCER SCREENING AND INCIDENCE IN AGING VETERANS INFECTED WITH HIV Michael S. Leapman 1 , Lesley S. Park 2 , Kimberly Stone 3 , Cynthia L. Gibert 4 , Matthew B. Goetz 5 , Roger Bedimo 6 , Roxanne Wadia 1 , Maria Rodriguez- Barradas 7 , Fatma Shebl 1 , Amy C. Justice 8 , Sheldon T. Brown 9 , Kristina Crothers 10 , Keith M. Sigel 3 1 Yale University, New Haven, CT, USA, 2 Stanford University, Stanford, CA, USA, 3 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 4 George Washington University, Washington, DC, USA, 5 University of California Los Angeles, Los Angeles, CA, USA, 6 University of Texas Southwestern, Dallas, TX, USA, 7 Baylor College of Medicine, Houston, TX, USA, 8 VA Connecticut Healthcare System, West Haven, CT, USA, 9 James J. Peters VA Medical Center, Bronx, NY, USA, 10 University of Washington, Seattle, WA, USA Background: Non-AIDS defining cancers are increasingly important contributors to health outcomes for aging persons with HIV (PWH). Although prostate cancer is prevalent in aging men, the impact of HIV infection on prostate cancer risk remains unclear and may be obscured by less screening in PWH. Therefore, we aimed to study longitudinal prostate cancer screening, incidence, and disease characteristics in Veterans Aging Cohort Study (VACS), a national cohort of PWH and uninfected controls. Methods: Using data from VACS (2000-2015) we identified a cohort of 119,336 (36,333 PWH, 83,003 controls) men ≥45 years of age. We ascertained PSA testing and prostate biopsy using relevant procedure codes, as well as incident prostate cancer diagnoses using linked cancer registry data. We calculated the incidence of PSA testing by HIV status and then fit multivariable Poisson models comparing the rates of PSA testing, prostate biopsy (among PSA tested persons) and prostate cancer incidence (in the whole cohort and restricting to only PSA tested persons) adjusting for age, race and smoking status. Among patients diagnosed with prostate cancer we compared Gleason grade and clinical stage. Results: Mean age at enrollment was 50 years, and patients were followed for a median of 15 years. A majority received at least one screening PSA test in the study period, including PWH (30,837, 85% ever tested) and controls (75,929, 92%). Prostate cancer was diagnosed in 966 PWH and 2,778 controls. The adjusted incidence of PSA testing over the study period was lower among PWH (IRR 0.80, 95% CI 0.79-0.81). Among PSA tested persons, HIV infection was associated with similar incidence of subsequent prostate biopsy (IRR 0.97, 95% CI 0.93-1.00). The incidence of prostate cancer was lower in PWH (IRR 0.86, 95% CI 0.77-0.91), including upon restriction to only individuals who received PSA testing (IRR 0.90, 95% CI 0.82-0.98). Among patients diagnosed with prostate cancer, there was a trend towards higher Gleason grade (p=0.10) and distant disease (p=0.09) among PWH that did not reach predefined thresholds for statistical significance.

Poster Abstracts

1073 SOCIOECONOMIC IMPACTS OF UNIVERSAL ANTIRETROVIRAL THERAPY IN THE SEARCH TRIAL Harsha Thirumurthy 1 , Aleksandra Jakubowski 2 , Yan He 1 , Jane Kabami 3 , Dalsone Kwarisiima 3 , Norton Sang 4 , Laura B. Balzer 5 , Tamara D. Clark 6 , Edwin D. Charlebois 6 , Gabriel Chamie 6 , Craig R. Cohen 6 , Elizabeth A. Bukusi 7 , Moses R. Kamya 8 , Maya L. Petersen 9 , Diane V. Havlir 6 1 University of Pennsylvania, Philadelphia, PA, USA, 2 Stanford University, Stanford, CA, USA, 3 Infectious Diseases Research Collaboration, Kampala, Uganda, 4 Kenya Medical Research Institute, Kisumu, Kenya, 5 University of Massachusetts Amherst, Amherst, MA, USA, 6 University of California San Francisco, San Francisco, CA, USA, 7 Kenya Medical Research Institute, Nairobi, Kenya, 8 Makerere University, Kampala, Uganda, 9 University of California Berkeley, Berkeley, CA, USA Background: Improvements in community health due to multi-disease health services and universal antiretroviral treatment have the potential to improve various socio-economic indicators, thereby informing cost-benefit calculations for such investments in healthcare. Methods: We conducted longitudinal socio-economic surveys over a 3-year period in households of approximately 100 HIV-infected and 100 HIV-uninfected adults sampled after baseline HIV testing in 30 pair-matched communities in the SEARCH trial (NCT01864603). Control communities received baseline multi-disease testing and antiretroviral therapy by national guidelines while intervention communities received annual testing and antiretroviral therapy irrespective of CD4 count via patient-centered care. Surveys assessed various outcomes including employment, consumption expenditures, asset holdings, survival expectations, and children’s school enrollment. The primary outcome was employment hours in the past week for individuals aged 18-65 years. Regression models with individual fixed effects and time trends were used to determine causal effects of the SEARCH intervention. Effects were examined for subgroups of HIV-positive adults with CD4 cell counts ≥500 and <500 cells/ mm3, their HIV-negative household members, and HIV-negative individuals in households without an HIV-positive adult. Results: Longitudinal data were collected for 34,396 individuals from 5,283 households. Adults worked an average of 29.6 hours and the majority of employment occurred on households’ own farms. Total employment hours among all adults did not change significantly due to the SEARCH intervention but among baseline HIV-positive adults, the intervention increased employment by 6.1 hours (p<0.001). Effects were largest among HIV-positive adults with baseline CD4≥500 (increase of 9.9 hours, p<0.01). Children in households with an HIV-positive adult were 5.3 percentage points more likely to complete

CROI 2019 422