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2240. Characteristics of Lung Cancer Treatment in Recent ART-era HIV+ Patients

Abstract Background Human immunodeficiency virus (HIV) infection is independently associated with lung cancer risk. Due to the aging of the U.S. HIV+ cohort, a high prevalence of smoking and lower rates of HIV-related mortality, lung cancer is now a major source of mortality in this group. Little is known about the tolerability of lung cancer treatment in HIV+ persons in the recent antiretroviral therapy (ART) era. Methods We identified 84 HIV+ patients and 48 uninfected comparators (matched by age, sex and cancer stage) who were diagnosed with lung cancer between 2006 and 2017 in our New York health system and collected data on treatment of HIV and treatment of lung cancer as well as adverse outcomes from electronic medical charts. We then compared characteristics, treatments and adverse treatment outcomes for HIV+ patients and controls. Results Subjects did not differ by HIV status in regards to age and sex (both P > 0.3) but HIV+ were more likely to be black or Hispanic and less likely to be white (P = 0.001). The prevalence of most major comorbidities did not differ by HIV status although chronic kidney disease and chronic hepatitis C infection were more common in HIV group (P = 0.001). There was no difference in histologic subtype or cancer stage of lung cancer by HIV status. Surgery was performed in 65% of HIV+ and 78% of uninfected patients that were stages I-IIIA (P = 0.4). Radiosurgery was performed in 8% of stage I HIV+ compared with no uninfected patients (P = 0.04). Chemotherapy was administered less frequently in HIV+ patients; 44% vs. 62% (P = 0.04). The most frequent chemotherapy complication for HIV+ patients was early chemotherapy termination (44%; P = 0.1) with a trend toward more frequent dehydration and fever in HIV+ patients (all P = 0.1 for comparisons to uninfected). Other chemotherapy complications in HIV+ patients included nausea (25%), anemia (11%), neutropenia (11%), diarrhea (11%), and thrombocytopenia (8%; all p>0.05 for comparisons with uninfected). Conclusion In our cohort from the recent ART-era we found some lung cancer treatment disparities in HIV+ patients. We found no major differences in chemotherapy toxicity associated with HIV status. Future research should further evaluate barriers to optimal lung cancer care within the HIV+ population. Disclosures All authors: No reported disclosures.


Immunogenicity and safety of four-vs. three-standard doses HBV vaccination in HIV-infected adults with isolated anti-HBc antibody
HIV-infected patients have decreased serological response to HBV vaccination with faster decline of protective antibody (Ab) titer. In those with isolated anti-HBc Ab, the role of vaccination remains controversial. We, therefore, conducted this study aimed to determine immunogenicity and safety of four-vs. three-standard doses HBV vaccination in HIV-infected adults with isolated anti-HBc antibody.
Methods. An open-label randomized controlled trial with 1:1 allocation was conducted among HIV-infected patients attending the Infectious Diseases clinic of the Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand between July and September 2017. Eligibility participants must be ≥18 years old, taking cART, CD4 ≥200 cells/mm 3 , HIV VL < 20 copies/mL, and positive isolated anti-HBc Ab. The participants were randomized to receive either threestandard-doses (20 µg at Months 0, 1, 6) or four-standard-doses (20 µg at Months 0, 1, 2, 6) IM HBV vaccination and were evaluated for anamnestic response at Week 4 after the first dose and response at Week 28. Predictive factors for anamnestic response and vaccine responders at Week 28 were analyzed.
Results. Of the total of 97 patients screened, 54 participants were enrolled and randomized. Thirty-two participants were male (59.3%) with the mean age of 46 years old. Anamnestic response occurred in 25.9% vs. 33.3% in three doses vs. four doses arm respectively (P = 0.551). After vaccination, the response rates at Week 28 were 85.2% in three doses arm vs. 88.9% in four doses arm (P = 1.000); with 44.4% vs. 63.0% being high-level responders, respectively (P = 0.172). GMT of anti-HBs Ab at Week 28 in three doses arm and four doses arm were 63.8 and 209.8 mIU/mL, respectively, P = 0.030. No adverse events were reported. A younger age (<45 years old) and higher nadir CD4 count (≥100 cells/mm 3 ) were independently predictive factors of anamnestic response with the odd ratio (OR) of 17.4 (95% CI 3.0-102.0) and 21.6 (95% CI 2.7-170.4) respectively. No predictive factors of responders at Week 28 were found.
Conclusion. In Thai HIV-infected patients with isolated anti-HBc Ab, anamnestic response occurred considerably with both regimens, but the majority was still unprotected. Hence, a single dose vaccination is insufficient. The usual three-standarddoses vaccination was highly effective with high response rate.
Disclosures. Methods. We compared CRC screening rates and outcomes among HIV-infected and demographically-matched HIV-uninfected subjects in a large integrated healthcare system. Using electronic health records, we identified subjects aged 50-75 years during 2005 to 2016 with no prior CRC screening. We evaluated time to first CRC screen (FIT, sigmoidoscopy or colonoscopy) using Kaplan-Meier estimates, and compared adenoma and CRC prevalence following first sigmoidoscopy or colonoscopy, by HIV status. Adjusted prevalence ratios (PR) accounted for sex, age, race, smoking status, body mass index, and diagnosis of type 2 diabetes or inflammatory bowel disease. Among HIV-infected subjects, we also evaluated whether CD4 count (<200, 200-499, ≥500) was associated with screening outcome.
Conclusion. In a setting with overall high screening uptake, we found similar adenoma and CRC prevalence in individuals with and without HIV. Our findings suggest that current CRC screening guidelines for the general population are also suitable for the HIV population.
Disclosures. M. Silverberg, Gilead: Grant Investigator, Grant recipient. Background. Human immunodeficiency virus (HIV) infection is independently associated with lung cancer risk. Due to the aging of the U.S. HIV+ cohort, a high prevalence of smoking and lower rates of HIV-related mortality, lung cancer is now a major source of mortality in this group. Little is known about the tolerability of lung cancer treatment in HIV+ persons in the recent antiretroviral therapy (ART) era.

Characteristics of Lung Cancer Treatment in Recent ART-era HIV+ Patients
Methods. We identified 84 HIV+ patients and 48 uninfected comparators (matched by age, sex and cancer stage) who were diagnosed with lung cancer between 2006 and 2017 in our New York health system and collected data on treatment of HIV and treatment of lung cancer as well as adverse outcomes from electronic medical charts. We then compared characteristics, treatments and adverse treatment outcomes for HIV+ patients and controls.
Results. Subjects did not differ by HIV status in regards to age and sex (both P > 0.3) but HIV+ were more likely to be black or Hispanic and less likely to be white (P = 0.001). The prevalence of most major comorbidities did not differ by HIV status although chronic kidney disease and chronic hepatitis C infection were more common in HIV group (P = 0.001). There was no difference in histologic subtype or cancer stage of lung cancer by HIV status. Surgery was performed in 65% of HIV+ and 78% of uninfected patients that were stages I-IIIA (P = 0.4). Radiosurgery was performed in 8% of stage I HIV+ compared with no uninfected patients (P = 0.04). Chemotherapy was administered less frequently in HIV+ patients; 44% vs. 62% (P = 0.04). The most frequent chemotherapy complication for HIV+ patients was early chemotherapy termination (44%; P = 0.1) with a trend toward more frequent dehydration and fever in HIV+ patients (all P = 0.1 for comparisons to uninfected). Other chemotherapy complications in HIV+ patients included nausea (25%), anemia (11%), neutropenia (11%), diarrhea (11%), and thrombocytopenia (8%; all p>0.05 for comparisons with uninfected).
Conclusion. In our cohort from the recent ART-era we found some lung cancer treatment disparities in HIV+ patients. We found no major differences in chemotherapy toxicity associated with HIV status. Future research should further evaluate barriers to optimal lung cancer care within the HIV+ population.
Disclosures. All authors: No reported disclosures. Background. Due to HAART and consequent decline in mortality from infectious complications, HIV patients have an increasing burden of non-AIDS defining cancers. Immunotherapy, consisting of PD1/PDL1 inhibitors, has revolutionized the treatment of cancers but data on their safety and efficacy is unknown in HIV patients, as they were excluded from clinical trials due to concern for unforeseen side effects.

Outcomes of Program Cell Death Protein 1 (PD-1) and Programmed Death-Ligand 1(PD-L1) Inhibitor Therapy in HIV Patients with Advanced Cancer
Methods. This is the largest retrospective study, involving 17 patients with HIV, treated with one of the 4 PD-1/PD-L1 inhibitors (Nivolumab, Pembrolizumab, Atezolizumab, Durvalumab or Avelumab) for cancer.The objective of our study was to evaluate the efficacy and safety profile of PD-1 and PD-L1 inhibitors in Cancer patients with HIV and also to assess the impact of these drugs on HIV infection control, specifically CD4 count and HIV viral load.
Results. Ten out of 17 patients responded to therapy. Of the 10 patients who responded to therapy, seven were alive and four were still on therapy. Ten patients including all seven non-responders died; nine died from cancer progression and one from sepsis after discontinuing HAART. The minimum duration of response was 15 weeks with one ongoing response at 34 weeks (similar to non HIV patients). Adverse events (Grade 1 or 2) were noted in seven patients while one stopped therapy due to pneumonitis. CD4 count was stable on treatment and HIV RNA was undetectable (became undetectable in one patient with initial low HIV viremia) (Table1).
Conclusion. PD-1 and PD-L1 inhibitors have transformed cancer treatment. Our data shows that they have equal efficacy, tolerable side effects with no effect on HIV markers when used in HIV patients with cancer. We strongly advocate inclusion of HIV cancer patients in clinical trials and support the use of PD1/PDL1 inhibitors in them.  Our aim was to determine the clinical characteristics and treatment patterns of prostate cancer in HIV patients. Data were analyzed in SPSS 22, New York, USA.

Clinical Characteristics and Treatment Patterns of Prostate Cancer in HIV-
Results. There were 1,752 HIV patients treated in our institution. We identified 45 (2.56%) patients with prostate cancer. The mean age was 62.09 (SD ± 5.99) years. Most patients were African American (73.3%). Alcohol consumption, smoking and drug use were reported by 53.3, 51.1 and 31.1% of patients, respectively. The most common comorbidities were hypertension (68.9%) and hyperlipidemia (51.1%). Most patients (80%) had undetectable HIV viral load. The mean CD4 count was 576.84 (SD ± 241.12) cells/uL. The majority of patients (88.89%) were on antiretroviral therapy. Most patients (86.7%) were referred for prostate biopsy after an elevated PSA level. Lower urinary symptoms were reported by 51% of patients. By digital rectal examination, 60% presented prostate enlargement and 13.3% nodules or masses. The mean PSA and Gleason score were 13.96 (SD ± 14.43) and 7.07 (SD ± 1.01) respectively. Most patients were at clinical stage T1c N0 M0 (86.7%). They were treated with surgical prostatectomy in 37.8% of cases (radical prostatectomy in 20% and robotic prostatectomy in 17.8%) and radiation therapy in 55.6% of cases (along with antiandrogen therapy in 33%). Androgen deprivation therapy alone or active surveillance was used in 6.7%. After a mean follow-up of 42.3 (SD ± 35.55) months, most patients were alive (88.9%). There were five deaths, four-related to other malignancies and only one due to metastatic prostate cancer.
Conclusion. Most HIV-infected veterans were diagnosed with prostate cancer at early stages. HIV status does not seem to affect the prognosis of patients with prostate cancer, which was demonstrated by the good outcomes observed in our study.
Disclosures. All authors: No reported disclosures. Methods. HIV outcomes for patients seen in the multidisciplinary clinic (≥2 visits) from 2012 to 2016 (N = 51) were compared with a historical cohort seen from 2007 to 2011 (N = 565).

Improving HIV Outcomes Among HIV-Infected Patients Diagnosed with
Results. In the pre-vs. post-integration cohorts, the median age at cancer diagnosis was 51 vs. 46 years (range 24-76, P = 0.01), 78% vs. 72% were male (P = 0.37), and 86% vs. 73% were African American (P = 0.04). 53% in the post-cohort had stage IV disease vs. 32% in the pre-cohort. In both cohorts, less than half were on HIV therapy at the time of cancer diagnosis (42% pre-and 43% post-, P = 0.91). Baseline median CD4 count at cancer diagnosis in the post-cohort was lower (171, IQR 70-310) than the pre-cohort (274, IQR 120-462; P = 0.20), and baseline median HIV viral load was higher (post-16,802 vs. pre-1,985). Viral suppression at cancer diagnosis was similar (42% pre-vs. 40% post-), but at study end, 75% of patients in the post-cohort had viral suppression vs. 63% in the pre-cohort (P = 0.09). Patients followed in the integrated clinic were 1.41 (95% CI, 0.91, 3.53) times more likely to be virally suppressed at end of follow-up compared with patients from the pre-integration cohort.
Conclusion. HIV-infected patients who received care at the multidisciplinary, integrated HIV clinic were more likely to be virally suppressed at the end of study follow-up compared with patients who received HIV care at the medical center prior to HIV clinic incorporation. Integrating HIV care into Cancer Centers may improve HIV treatment outcomes for these dually diagnosed, medically fragile, and complicated patients.
Disclosures. All authors: No reported disclosures.