CROI 2019 Abstract eBook

Abstract eBook

Oral Abstracts

1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 Emory University, Atlanta, GA, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 University of Pittsburgh, Pittsburgh, PA, USA, 5 Johns Hopkins University, Baltimore, MD, USA, 6 Minneapolis VA Health Care System, Minneapolis, MN, USA Background: Based on the National Lung Screening Trial (NLST), US Preventive Services Task Force (USPSTF) recommends screening with low-dose chest computed tomography scan for adults aged 55-80 with >30 pack-year smoking history who are current smokers or quit within the last 15 years. Persons living with HIV (PLWH) are at increased risk for lung cancer but were excluded from the NLST. This study evaluated the performance characteristics of NLST criteria in confirmed lung cancer cases and matched controls from observational cohorts of men and women with HIV. We also explored alternative thresholds to improve lung cancer detection rates. Methods: We selected all confirmed lung cancers among PLWH who were current/former smokers and ≥40 years at diagnosis in the Women’s Interagency HIV Study (WIHS) and the Multicenter AIDS Cohort Study (MACS). Controls, selected from each cohort, were PLWH with no reported lung cancer during all follow-up visits, matched on 5-year age windows. Clinical and demographic characteristics, and proportions meeting NLST screening criteria, were compared. Alternative thresholds included iterative reductions in age, pack- years, and quit date. Results: We identified 44 WIHS women and 17 MACS men with HIV and incident lung cancer (Table). Lung cancer incidence was 270 and 104 per 100,000 person-years in women and men, respectively (p<0.001). Race and income did not differ between cases and controls. Compared to controls, women with lung cancer had a significantly lower median CD4 count but no significant difference in median viral load. In men, there were no significant differences in these markers of HIV infection between cases and controls. Only 16% of women and 24% of men with lung cancer met USPSTF screening criteria. Optimal age and pack-year screening criteria in women (age 49-75, ≥16 pack-year history) yielded 52% sensitivity and 75% specificity. In men, optimal criteria (age 43-75, >19 pack-year history) yielded sensitivity (82%) and specificity (76%). Conclusion: Current USPSTF lung cancer screening guidelines performed poorly in PLWH, as <25% of lung cancer cases met criteria. Alternative thresholds of age, smoking history, and quit date can better identify PWLH to screen for lung cancer. Among PLWH, lung cancer risk was higher in women than men. This study demonstrates the need for risk prediction modeling incorporating sex and markers of HIV infection to identify high risk individuals who would benefit from screening despite not meeting current USPSTF criteria.

1 Brigham and Women’s Hospital, Boston, MA, USA, 2 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 3 Botswana Ministry of Health, Gaborone, Botswana, 4 Life Gaborone Private Hospital, Gaborone, Botswana, 5 Massachusetts General Hospital, Boston, MA, USA, 6 University of Pennsylvania, Philadelphia, PA, USA, 7 Brigham and Women’s Hospital, Boston, MA, USA Background: Breast cancer is the second leading cause of cancer death among women living with HIV (WLHIV) with access to ART. In the context of ART coverage exceeding UNAIDS 90-90-90 targets, we sought to prospectively assess the impact of HIV on overall survival of women with breast cancer. Methods: As part of the Thabatse Cancer Cohort, we included women presenting (October 2010 to March 2018) for initial treatment of breast cancer at one of four oncology centers in Botswana. Consenting patients were interviewed, records abstracted, and followed for up to 5 years. The association between HIV infection and all-cause mortality was assessed using a multivariable Cox proportional hazards model including covariates selected a priori: cancer stage, curative versus palliative intent, receptor status, age, and personal income. Results: A total of 430 women with breast cancer with known HIV status were enrolled (4 women with unknown HIV status excluded), including 135 (31.4%) WLHIV and 295 (68.6%) uninfected women. WLHIV were younger than uninfected women, median 47.5 and 55.5 years, respectively (p<0.001). Among WLHIV, 110 (84%) were on ART prior to cancer diagnosis (median duration 6.8 years) and median CD4 count was 513 cells/μL. Advanced cancer stage (III/IV) was common for both WLHIV (67%) and uninfected women (66%). Immunohistochemistry results were available for 250 women (58%); 154 (62%) women were ER+ and 65 (26%) were triple-negative. Receptor status was similar by HIV status (p=0.89). The majority (69%) received multimodality treatment with curative intent and the proportion did not differ by HIV status (p=0.80). After 847 patient-years of follow-up, 156 women died, including 66 (49%) WLHIV and 90 (31%) uninfected women. Three women (0.7%) were lost to follow-up. The majority of deaths (141, 90%) were attributed to cancer and none to HIV. Two-year survival for WLHIV was lower than those without HIV, 57% and 73%, respectively (see Figure, p<0.001). Findings were similar in adjusted analyses with WLHIV experiencing higher mortality (hazard ratio 1.86, 95%CI 1.33 to 2.61, p<0.001). Cancer stage, treatment intent, and personal income less than $50/month were also inversely predictive of survival (p<0.001 for each). Conclusion: HIV infection is associated with substantially higher non-AIDS mortality among women with breast cancer. Improved understanding of mechanisms underlying excess mortality could contribute to improved outcomes in the majority female and aging African HIV epidemic.

Oral Abstracts

16 HIV IS ASSOCIATED WITH DECREASED BREAST CANCER SURVIVAL: A PROSPECTIVE COHORT STUDY Katrin S. Sadigh 1 , Ryan M. Hodgeman 2 , Neo Tapela 3 , Isaac Nkele 2 , Memory Bvochora-Nsingo 4 , Sebathu Chiyapo 4 , Tlotlo B. Ralefala 3 , Jason A. Efstathiou 5 , Oaitse John 2 , Galaletsang Motswetla 2 , Surbhi Grover 6 , Jerry Younger 5 , Mompati O. Mmalane 2 , Shahin Lockman 7 , Scott Dryden-Peterson 7

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CROI 2019