Introduction Stroger Hospital of Cook County (CCH) and Ruth M. Rothstein CORE Center (CC) are the largest health providers for HIV + patients in Chicago and among the largest in the United States. Together, CCH and CC treat over 5500 HIV + individuals per year and 60 newly diagnosed HIV-associated cancers yearly. In addition CCH is the largest safety net hospital in the Chicago, and in the calendar year 2010 had over 32,000 outpatient hematology/oncology clinic visits. Classical Hodgkin lymphoma (cHL) is the second most common non-AIDS defining cancer at CCH. Recent reports have suggested that the outcomes of HIV (HIV-cHL) vs. non-HIV associated cHL were similar. Many of these studies were multi-institutional, and insights into the inner-city cancer population have yet to be described. In addition, many of these studies compared outcome data to historical controls obtained at different institutions. To gain insights into the racial composition and survival data of patients with cHL, we compared all of disease characteristics and demographic information of HIV-associated and non-HIV cHL at CCH and the CC from the past 15 years. Methods We identified via CCH and CC databases HIV-infected patients with cHL from 1998–2013. We subsequently identified the HIV characteristics, cancer type, overall survival (OS) data, and patient demographics for all patients. Four hundred patients with cHL were screened. Only patients that had complete overall survival and demographic information were included in the study. One hundred seventy-nine non-HIV and 40 HIV-cHL met these criteria. In addition, all patients analyzed were treated with the same treatment regimen, Adriamycin, Bleomycin, Vinblastine, and Dacarbazine (ABVD). Statistics Non-parametric Fisher's exact test was used to examine the difference in proportion of patients in both the HIV and non-HIV arm. Survival data were analyzed using Kaplan-Meier analysis and Cox Proportional Hazards model. Results The M:F ratio was 8.5:1 in HIV-cHL and 2.4:1 in the non-HIV cohort (P<0.001). The median CD4+ count for the HIV population was 204 cells/mm3. The racial composition of the 2 cohorts showed a significant increase in the percentage of African-Americans (AA) in the HIV cohort, 69% vs. 44% in the non-HIV, (p<0.001) and Caucasians, 8% vs. 20% (p<0.001) respectively. Compared to the general Chicago AA population of 23%, a disparity of 46% exists. The difference in the Hispanic population between the 2 groups was not significant (24% vs.29% (p < 0.6)). The HIV-cHL population was older (37 vs. 29 years) than in non-HIV patients. The most frequent histological subtype of HIV-cHL was mixed cellularity cHL 44% vs. 13% in the non-HIV cohort. The most common histological subtype was nodular sclerosis in the HIV negative group (72%). The HIV positive patients tended to present with more advanced disease, compared to the HIV negative patients. Fifty six % vs. 42% in the non-HIV cohort presented with stage III/IV disease though these changes were not significant. Notably, 35% of HIV patients who presented with advanced stage cHL, presented with an IPS score of 5/6 compared to just 8% in the non-HIV cohort (p<0.01). The 10-year OS of the stage I/II and III/IV HIV-cHL patient compared to the non-HIV cHL patients showed no statistical significant difference in Stage I/II (98% vs.91%, p = 0.52), and stage III/IV (80% vs. 73%, p= 0.82; HIV vs. non-HIV). No other statistical difference was noted with respect to OS accounting for race, gender, histology, or age. Conclusions In assessing the cases of HIV-cHL, it appears to be a disease of AA (69% vs. 44%) men (90% vs 70%) compared to the non-HIV population at the same institution. But when compared to the general population of Chicago, where AA constitute only 23% of the population, the disparity is more pronounced. In addition, the HIV-cHL patients present with more advanced disease (80% vs 73%). Of the patients with advanced cHL, 35% vs. only 8% (p<0.001) have an IPS score of 5/6 compared to the non-HIV cohort. Although HIV patients present with more aggressive cHL histology, mixed cellularity cHL, than the non-HIV cohort (44% vs.13%), higher stage, and a statistically significant higher IPS score, little difference in OS was noted when compared to the HIV negative patients. Thus, education and screening, in the AA community is needed, not just to lower the incidence of HIV, but HIV-cHL as well. Disclosures: No relevant conflicts of interest to declare.
e12523 Background: From 1991 to 2005, the number of cases of non-AIDS defining cancers (NADC) rose from 3,192 to 10,059 in the USA. Studies have shown an improvement in survival for many HIV-associated malignancies in the post HAART era. Drug-drug interactions between HIV therapy and chemotherapy (CTX) are not well understood. HIV medications can inhibit or induce the cytochrome p450 system, modulating CTX clearance. To understand CTX-HIV medication interactions, we performed a retrospective analysis of all patients (pts) diagnosed with a solid NADC who took CTX with combined antiretroviral therapy (cART). Methods: 157 pts with solid NADC were identified via a computer search at County Hospital. Adverse events (AE) during CTX in pts taking cART were assessed by chart review and graded per the NCI Common Terminology Criteria. Statistics: A Fisher's exact test was used to examine the differences in AE incidence. Results: Patients who did not take cART in conjunction with, or did not require CTX, were excluded. The number of pts analyzed for anal cancer (n=25), lung carcinoma (n=9), breast (n=7), and head and neck carcinoma (HNSCC) (n=4) represents 94% of pts taking cART with CTX in our cohort. Interestingly, Forty-two pts (50%) never received cART during therapy. All pts with anal carcinoma were treated with mitomycin/5FU/radiotherapy. 46 % of the patients taking ritonavir-based cART (6 pts of 13) developed a G4 neutropenia versus 8% (1 pt of 12) taking non-ritonavir cART (p<0.07). Anemia all grades with ritonavir, 54%, versus non-ritonavir cART 16% (p<0.09). All grades neutropenia for lung carcinoma while taking ritonavir was 83% versus 33% while taking non-ritonavir cART. No other correlations were identified. In this cohort, 17 pts received platinum (37%), taxanes (n=5) (11%), anthracyclines (n=5) 11%, gemcitabine (n=2) (4%), and pemetrexed (n=1). No difference in AE was noted between any CTX class, AE, and cART. Conclusions: Ritonavirinduced a 38% increase in G4 neutropenia and anemia during treatment of anal carcinoma with mitomycin/5FU. More trials including HIV-associated cancer pts are needed to assess the role of cART when given in conjunction with CTX.
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