PROJECT SUMMARY/ABSTRACT Advances in anti-retroviral therapy have transformed HIV into a chronic disease. As death from HIV has decreased for people living with HIV (PLWH), mortality from other chronic diseases of aging, particularly non- AIDS defining cancers (NADC), has significantly increased. Winship Cancer Institute’s P30 cancer center support grant and its Community Outreach and Engagement component have identified PLWH as a “Special Population”, experiencing significant cancer disparities in our catchment area of Georgia. Multiple retrospective database analyses have reported worse cancer outcomes, including survival, between PLWH vs HIV- populations, but underlying reasons to explain significant differences in cancer care and survival outcomes more fully remain to be elucidated. We propose two Specific Aims for this exploratory supplement: 1) generate a population-based cohort of age- and stage-matched HIV+ and HIV- NHL patients derived from the Georgia cancer registry; and 2) contact this cohort using established registry protocols and evaluate feasibility and acceptability of validated tools and methods to investigate social determinants of health and multi-level factors (patient, clinical, facility, provider, system) that might impact diagnosis, treatment and outcomes for both HIV+ and HIV- cancer cases through a mixed methods study design. These Aims are in alignment with the NIH OAR research priorities related to HIV-Associated Comorbidities, Coinfections, and Complications that contributes to increasing understanding of the causes, frequency, and clinical outcomes of HIV-related malignancies, as well as research to reduce Health Disparities … in treatment outcomes of PLWH. Completion of these Aims will lead to an extramural grant application to expand preliminary data to other NADC.

PROJECT NARRATIVE People living with HIV (PLWH) are living longer but are at higher risk for being diagnosed with and dying from other chronic diseases, such as cancer. In addition to changes to the immune system from HIV and its treatment, PLWH may experience worse outcomes from cancer due to social determinants of health (SDOH), such as education level. This population-based study will examine how SDOH may impact cancer outcomes for patients with HIV positive or HIV negative cancer called non-Hodgkin lymphoma.