Gastrointestinal Cancer

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SU_4_2039 - Impact of immune status on disease recurrence in HIV+ positive patients diagnosed with anal dysplasia

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Impact of immune status on disease recurrence in HIV+ positive patients diagnosed with anal dysplasia
D. Seneviratne1, and E. C. Fields2; 1Virginia Commonwealth University, Richmond, VA, 2VCU Massey Cancer Center, Richmond, VA

Purpose/Objective(s): HIV positivity (+) is associated with the development of HPV-related anal dysplasia, a precursor to anal carcinoma. In cervical cancer, the degree of immunosuppression has been shown to impact the severity of the disease. Although treatment of dysplasia and malignant disease should be the same in the HIV + population, various biologic and social issues may impact treatment and outcomes. We hypothesized that the degree of immunosuppression and psycho-social factors impact disease outcomes among HIV+ patients with anal dysplasia. We aim to investigate the relationship between immune status and dysplasia recurrence to help improve the management of this population.

Materials/Methods: A retrospective cohort of 146 HIV+ patients diagnosed with anal dysplasia between 2003-2017 at a single institution was identified. Immunosuppression and patient demographic data were collected through chart review. 71/146 patients received treatment, and immune status data was available for 69 patients. Independent T-tests and Mann-Whitney tests were used to assess the impact of immune status at dysplasia diagnosis on post-treatment disease recurrence, and to determine whether immune status differed with race.

Results: Patients with recurrent disease (N= 24, 41.3%) demonstrated a significantly lower mean CD4 count and a CD4/CD8 ratio at time of dysplasia diagnosis in comparison to those who remained disease free (N=34, 58.6%) CD4 306 vs. 483 (p = 0.01); CD4/8 0.32 vs. 0.53 (p = 0.0064). In fact, analysis of markers of immunosuppression at all available time points (mean entries/patient- 25, range-3-101) demonstrated that patients with recurrences (N=26) had a significantly lower median CD4 count and a CD4/CD8 ratio in comparison to patients without recurrences (N=43), CD4 -379 vs. 432, (p<0.01); CD4/CD8- 0.4 vs. 0.5, (p<0.001). Among patients with disease recurrence, analysis of immunological markers demonstrated significantly lower median values at the time of initial dysplasia diagnosis in comparison to the times of subsequent recurrences, CD4- 261 vs. 450 (p = 0.011); CD4/CD8- 0.3 vs. 0.4 (p<0.003). Additionally, significantly lower median CD4, CD3, and CD4/CD8 ratios were observed among African American patients (N= 113, 76%) in comparison to Caucasian patients (N=35, 23.6%) CD4- 425 vs. 540 (p< 0.0001); CD3- 1350 vs. 1411, (p<0.003); CD4/CD8- 0.5 vs. 0.6, (p<0.001).

Conclusion: Patients with recurrent anal dysplasia and African American patients had increased immunosuppression at the time of diagnosis and throughout their treatment and follow up, suggesting that earlier intervention with anti-retroviral therapy could prevent or delay the morbidity and anxiety of additional treatments. Additionally, earlier intervention could decrease the rates of transformation of these lesions into invasive malignancies requiring chemoradiation.

Author Disclosure: D. Seneviratne: None. E.C. Fields: None.

Danushka Seneviratne, MD, PhD

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