1597Treatment of Oropharyngeal Cancer in Patients with Human Immunodeficiency Virus

Background. The incidence of oropharyngeal squamous cell carcinoma (OPC) is on the rise. This is now known to be largely due to infection with human papillomavirus (HPV), the most common sexually transmitted disease in the world. Patients with human immunodeficiency virus (HIV) are particularly susceptible to all HPV-associated malignancies including OPC, but very little is known to guide their treatment. Studies of other malignancies suggest that patients with HIV experience significant delays in therapy compared to HIV-negative patients. We wished to determine whether this was the case in OPC. Methods. We obtained treatment data for all HIV-positive subjects diagnosed with OPC at the Hospital of the University of Pennsylvania from January 1, 1996 through April 11, 2013 and compared it to a subset of HIV-negative subjects with OPC diagnosed during the same time period. This information is part of a larger, ongoing multicenter retrospective cohort to evaluate the treatment and survival outcomes of OPC in HIV-positive patients. The primary endpoint was time from diagnosis until start of therapy; a difference of 10 days was deemed clinically important based on studies that showed increased mortality in patients with delays longer than this. Results. 19 HIV-positive subjects and 86 HIV-negative subjects with treatment data were identified. The unadjusted hazards ratio for starting therapy in HIV-negative patients was 2.71 (95% confidence interval 1.54-4.76) compared to HIV-positive patients. This hazards ratio was 2.31 (95% confidence interval 1.22 – 4.37) after adjustment for age, sex, insurance type, race, and comorbidities including psychiatric disease and substance abuse. The median number of days from diagnosis to start to therapy was 27 in HIV-negative patients (interquartile range 14-39) and 51 in HIV-positive patients (interquartile range 31-85). Conclusion. HIV-positive subjects with OPC experience clinically important delays from diagnosis until start of therapy compared to HIV-negative patients. A larger study is underway to explore potential mechanisms for these delays and to determine how this impacts survival. Disclosures. All authors: No reported disclosures.