2243. Improving HIV Outcomes Among HIV-Infected Patients Diagnosed with Cancer and Followed in an Integrated, Multidisciplinary, Infectious Disease/Cancer Clinic. (26th November 2018)

• Record Type: Journal Article
• Authors: Cheung, Helen; Stafford, Kristen A; Riedel, David J
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S663
• Page End: S663
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1896
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Patients dually diagnosed with HIV and cancer have poorer outcomes compared with general cancer patients. HIV management in the setting of cancer is complicated by multiple specialist involvement, drug–drug interactions, and overlapping drug toxicities. Past studies of HIV-infected patients noted improved virologic suppression, CD4 counts, and adherence with access to multidisciplinary services. A multidisciplinary clinic (HIV specialists (doctors and nurses), pharmacists, social workers, etc.) embedded in the University's Outpatient Cancer Center starting in late 2011 sought to improve virologic suppression and care coordination for dually diagnosed patients. 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). 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.