2244. Non-AIDS Cancers Contribute to an Increasing Proportion of Deaths in Persons Living with HIV at a Single University-Based Clinic

Abstract

BackgroundMortality for people living with HIV (PLWH) has drastically decreased since the mid-1990s, and the proportion of deaths due to non-HIV-related conditions has increased.MethodsDeceased PLWH were identified within a single academic medical center. Cause of death was determined by chart review, clinic providers, and when available autopsy and toxicology data. Chart review of comorbidities, demographics and preventable causes of cancer was conducted for deaths during the period of 2013–2017.ResultsThe proportion of AIDS-related deaths decreased markedly between 1995 and 2017, while the proportion of deaths from non-AIDS cancers has increased (figure). Patients with non-AIDS cancers were older, had a higher CD4 count and greater proportion with undetectable viral load, and were more likely to be male; over 80% were current or prior smokers (table). Among all deaths from 2013 to 2017, 44% of eligible patients received colon cancer screening, 66% received cervical cancer screening, and 29% received breast cancer screening. Of patients who died from HCC, one out of six had imaging for HCC within 1 year and none within 6 months of diagnosis.ConclusionImprovements in cancer screening and preventative health measures including smoking cessation and lifestyle improvement education may help to reduce the increasing proportion of non-AIDS cancer-related deaths among PLWH. Characteristics by Cause of Death (2013–2017)HIV-Related Cancer ‡ P-value N 2224Age at death50 (44, 56)56 (53, 61)0.03Last available CD472(15, 249)207(94, 301.5)0.02Last available viral load < 50 copies5 (23)16 (67)0.004CD4 Nadir18(7, 110)77(35, 126)0.2Male14 (64)23 (96)0.009Smoking within 1 year of death9 (41)13 (54)0.8Smoking, quit 1-15 years prior to death5 (23)6 (25)Smoking, quit > 15 years prior to death1 (5)1 (4)Never smoked7 (32)4 (17)*Median (IQR) or n (%).‡ Most common: HCC (6), head/neck (4), prostate (3).Disclosures All authors: No reported disclosures.