{ "abstract": "Background Malignancies have become a major cause of morbidity and death in people with HIV (PWH) with a progressive shift from AIDS-defining cancers (ADCs) to non-AIDS-defining cancers (NADCs). We aimed to evaluate five-year mortality among PWH with malignancies.Materials and Methods We conducted a retrospective monocentric cohort study including adult PWH followed at the Department of Luigi Sacco Hospital (Milan, Italy) and diagnosed with cancer between 2000 and 2019. Follow-up ended on 31st December 2024. Cancers were classified as ADCs or NADCs, further stratified into virus-related and non–virus-related. Patients were grouped according to the period of cancer diagnosis: 2000–2007 and 2008–2019, based on the introduction of integrase inhibitors in clinical practice. Five-year all-cause and cancer-specific mortality were estimated by means of Kaplan Meier curves. Cox proportional hazards models were used to assess mortality risk across different periods, adjusting for sex assigned at birth, age, HIV transmission risk group, previous AIDS diagnosis, and HCV co-infection.Results Among 4,473 PWH, 472 patients (10.6%) developed at least one malignancy, accounting for 490 cancer diagnoses. At five years, 35.3% (95% CI 31.1–39.5) of PWH with a cancer diagnosis had died, with lower mortality observed in the more recent period (43.8% [95% CI 37.3–50.3] in 2000–2007 vs 28.2% [95% CI 22.8–33.6] in 2008–2019; p<0.001). Among ADCs, five-year all-cause mortality decreased markedly from 38.8% (95% CI 30.8–48.8) to 12.5% (95% CI 6.8–23.1), with a parallel reduction in cancer-specific deaths (aHR 0.28 [95% CI 0.13–0.58]; p<0.001). The greatest five-year all-cause mortality reduction was observed among PWH with non-Hodgkin lymphoma (aHR 0.33 [95% CI 0.14–0.77]). Virus-related NADCs also exhibited a significant all-cause mortality reduction, (56.1% [95% CI 42.8–73.5] to 31.2% [95% CI 21.5–45.4]; aHR 0.25 [95% CI 0.13–0.51]; p<0.001), particularly for hepatocellular carcinoma (aHR 0.13 [95% CI 0.05–0.36]). PWH with non–virus-related NADCs experienced a less pronounced decline in all-cause mortality, from 50.0% (95% CI 38.8–64.4); to 37.3% (95% CI 29.7–46.8), (aHR 0.48, 95% [CI 0.29–0.80]; p=0.005. Among PWH with lung cancer, five-year all-cause mortality decreased from 84.6% (95% CI 67.1–99.9) to 68.0% (95% CI 52.0–89.0), although this reduction was not statistically significant (aHR 0.41 [95% CI 0.14–1.20]; p=0.103) ( table 1, figure 1).Conclusions In our cohort, cancer-related mortality declined over time both for ADCs and virus related NADCs. Since the magnitude of the reduction was not the same for all NADCs, targeted prevention, early diagnosis, and optimized oncological care in aging PWH are warranted.Abstract P49 Table 1Five-year cumulative incidence of all-cause and cancer-specific mortality following diagnosis of AIDS-defining cancers, virus-related and non-virus-related non-AIDS-defining cancers, Kaposi sarcoma, non-Hodgkin lymphoma, lung cancer, anal cancer, and hepatocellular carcinomaAbstract P49 Figure 1Cumulative cancer-specific mortality from time of first cancer diagnosis among people with AIDS-defining cancers (top panel), virus-related non–AIDS-defining cancers (middle panel), and non–virus-related non–AIDS-defining cancers (bottom panel), stratified by period of cancer diagnosis (2000–2007 and 2008–2019)", "authors": [ { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "M Matone" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "G Pozza" }, { "affiliations": [ "Department of Oncology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "D Dalu" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "L Oreni" }, { "affiliations": [ "Department of Oncology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "C Fasola" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "MV Cossu" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "G Carrozzo" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "A Poloni" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "C Fusetti" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "D Moschese" }, { "affiliations": [ "Department of Oncology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy" ], "name": "N La Verde" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy", "Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy", "Centre for Multidisciplinary Research in Health Science (MACH), Milan, Italy" ], "name": "A Gori" }, { "affiliations": [ "Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy", "Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy" ], "name": "A Giacomelli" } ], "title": "P49 Five-year cancer mortality among people with HIV: a monocentric retrospective study", "uid": "7ddfbf39-ffc5-5279-bb52-bb64b657efff" }