2130. Survival after Cancer Diagnosis in an HIV-positive Population in Latin America
Session: Poster Abstract Session: HIV: Cancers, HPV, Dysplasia
Saturday, October 29, 2016
Room: Poster Hall
Background: After HAART introduction, cancer became a leading cause of death among persons with HIV. The aim of this study was to evaluate the trends and predictors of survival after cancer diagnosis in patients included in the CCASAnet cohort (Caribbean, Central, and South America network for HIV epidemiology).

Methods: Demographic, cancer, and HIV-related data from HIV-positive adults diagnosed with cancer (no more than 1 year before and any time after HIV diagnosis) between January 1, 2000 and June 30, 2015 were retrospectively collected. Cancer cases were validated and classified as ADC and NADC. The association of mortality with cancer- and HIV-related factors was assessed using Kaplan-Meier curves and unadjusted and adjusted Cox proportional hazards models stratified by site and cancer type.

Results: Among 15874 subjects, 789 had a cancer diagnosis as defined above; 82% were male and median age at cancer diagnosis was 39 years (interquartile range [IQR]: 32- 47). Patients were from Brazil (n=288, 36%), Argentina (n=157, 20%), Chile (n=156, 20%), Mexico (n=152, 19%), and Honduras (n=36, 5%). Patients characteristics are shown in the Table.
ADC (n=566) NADC (n=223) p
Median time between HIV diagnosis and cancer (years) (IQR) 0.84 (0.11-5.14) 5.1 (1.9-11) <0.001
Patients diagnosed before HAART start (%) 259 (46) 49 (22) <0.001
Median CD4 cell count at cancer diagnosis (cells/ul) (IQR) 89 (29-231) 384 (229- 573) <0.001
Patients with HIV viral load (VL) <200 (copies/mL) (%) 86 (30) 96 (67) <0.001

The overall survival probabilities at 1, 3, and 5 years after cancer diagnosis were 80%, 73% and 68%, respectively. Patients with NADCs had similar survival probabilities as those with ADCs at 1 year (81% vs. 80%) but had lower survival at 5 years (60% vs. 70%). In the adjusted analysis, mortality increased with time between cancer and HIV diagnoses (aHR=1.03 per year, p=0.01).

Conclusion: ADCs remain the most frequent cancers in the region. Patients with ADCs were more likely to have low CD4 count, detectable viral load, and untreated HIV infection compared to those with NADCs. Longer-term survival was lower after NADC diagnosis than for ADC, which may be due to factors unrelated to HIV. Efforts towards early HIV diagnosis and retention in antiretroviral treatment programs should be improved in the region. 

Valeria Fink, M.D.1, Cathy Jenkins, MS2, Jessica Castilho, MD, MPH3, Anna Person, MD4, Bryan Shepherd, PhD5, Beatriz Grinsztejn, MD, PhD6, Juan Sierra Madero, MD7, Claudia P Cortés, MD8, Denis Padgett, M.D.9, Carina Cesar, MD1, Héctor Pérez, MD10, Karu Jayathilake, M.S.11, Catherine Mcgowan, M.D.11 and Pedro Cahn, MD1, (1)Fundación Huésped, Buenos Aires, Argentina, (2)Vanderbilt University, Nashville, TN, (3)Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, (4)Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, (5)Vanderbilt Univ. Hosp., Nashville, TN, (6)Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil, (7)Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico, (8)Fundación Arriarán, Santiago, Chile, (9)Instituto Hondureño de Seguro Social and Hospital Escuela, Tegucigalpa, Honduras, (10)Infectious Diseases, Hospital Juan A Fernández, Buenos Aires, Argentina, (11)Vanderbilt University Medical Center, Nashville, TN


V. Fink, None

C. Jenkins, None

J. Castilho, None

A. Person, None

B. Shepherd, None

B. Grinsztejn, None

J. Sierra Madero, None

C. P. Cortés, None

D. Padgett, None

C. Cesar, None

H. Pérez, None

K. Jayathilake, None

C. Mcgowan, None

P. Cahn, None

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