Abstract B008: Survival outcomes in older people living with HIV and cancer
Authors: Carey Tishiya , Mangusan Ralph , Widell Anaida , Ekwede Irene , Lurain Kathyrn , Ramaswami Ramya 
Published: December 2023

Abstract
The success of antiretroviral therapy (ART) has led to an aging of the population of people with HIV (PWH). In the United States, over 50% of the 1.3 million PWH are currently over the age of 50. Studies have shown that PWH have advanced biological age as compared to the general population. Little is known about HIV and cancer characteristics in older PWH and the impact of these conditions on survival outcomes in this population. To evaluate this we conducted a retrospective review of PWH over the age of 60 years with cancer at the HIV and AIDS Malignancy Branch at the National Cancer Institute (NCI) from March 2001 to December 2021. We evaluated characteristics by age of intial cancer diagnosis (&lt;60 years vs. &gt;60 years) to determine the proportion of older PWH with a prior cancer diagnosis over their lifespan. We collected patient demographics, cancer and HIV characteristics, and other medical comorbidities. We calculated overall survival of patients from the age of 60 to last follow-up/death by Kaplan-Meier method and stratified by age at initial cancer diagnosis. We identified 32 patients (29 cisgender male, 3 cisgender female) who were seen in our clinic at the age of 60 years or older. 18 (56%) patients were diagnosed with cancer &lt; 60 years and 14 (44%) were diagnosed &gt; 60 years. 25 (78%) patients were non-Hispanic White and 7 (22%) were non-Hispanic Black. Kaposi sarcoma (20, 62%) was the most common cancer and cardiovascular disease (18, 56%) was the most common medical comorbidity in both age groups. Of the patients with cancer &lt; 60 years, 12 (67%) were diagnosed with 1 cancer, and 6 (33%) had two or more cancer diagnoses. Of the patients diagnosed with cancer aged &gt; 60 years, 8 (57%) were diagnosed with 1 cancer, and 6 (43%) were diagnosed with 2 or more cancers. Although patients diagnosed with cancer after 60 years presented with more comorbidities than patients diagnosed with cancer before 60, this was not significant (P= 0.72). HIV was well-controlled in all patients (median: 0 copies/mL, range: 0-216). The median CD4+ T cell count at age of cancer diagnosis was 420 cells/µl (range: 21-950) in those diagnosed &lt;60 and 196 cells/µl (range: 20-682) diagnosed &gt;60, which was not a significant difference (P= 0.54). All patients received cancer-directed therapy for their conditions. Of all patients 60 years and over who were evaluated, 12 patients (36%) died during follow-up, 10 of whom died of cancer. Of those who died during follow-up, 5 (26%) were diagnosed with cancer before 60 while 7 (50%) were diagnosed with cancer after age 60. Among all patients, the median overall survival was 6.8 years with a 5-year survival of 63%. There was no survival difference among those who were diagnosed with cancer before or after age 60 (P=0.10). As life expectancy improves among PWH, patients aged 60 years and over can experience one or more cancer diagnoses. Cancer care in this population requires a multidisciplinary approach that accounts for concurrent medical comorbidities that can impact the treatment course and survival outcomes.
Citation Format: Tishiya Carey, Ralph Mangusan, Anaida Widell, Irene Ekwede, Kathyrn Lurain, Ramya Ramaswami. Survival outcomes in older people living with HIV and cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B008.