CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

TUESDAY, FEBRUARY 24, 2015 Session P-R6 Poster Session

Poster Hall

2:30 pm– 4:00 pm Syphilis and HIV Coinfection 839 InfectionWith HIV Among Individuals With Primary and Secondary Syphilis: USA, 2013 John R. Su ; Akbar A. Zaidi; Elizabeth A.Torrone; Hillard S.Weinstock US Centers for Disease Control and Prevention, Atlanta, GA, US Background: Reports of primary and secondary (P&S) syphilis from large cities describe high proportions of co-infection with HIV among men who have sex with men (MSM). This analysis was performed to describe prevalence of co-infection across the U.S. during 2013. Methods: We reviewed data reported to CDC from counties reporting both sex of sex partner and HIV status (either HIV-positive or HIV-negative per self report, at time of syphilis diagnosis) for at least 70% of cases of P&S syphilis for 2013. The proportion of P&S syphilis cases co-infected with HIV (i.e., reported cases of P&S syphilis who were also HIV- positive) was calculated and stratified by sex and sexual behavior, race/ethnicity, age group, and census region of the U.S. Results: During 2013, 651 (58%) of 1,114 counties reporting cases of P&S syphilis from 44 states and Washington, DC met inclusion criteria. Of the 11,453 cases of P&S syphilis reported in these counties, 9,461 (83%) had both sex of sex partner and HIV status reported, of whom 42%were co-infected with HIV. Regardless of region, more than 40% of cases were co-infected (range: 41%–51%). Among individuals with P&S syphilis, 7,150 (76%) were MSM, 15%were men having sex with women only (MSW), and 9%were women. The highest prevalence of co-infection occurred among MSM (52% among MSM, compared to 11% among MSW and 5% among women). Prevalence of co-infection increased with age among MSM: 35% aged 15–24 years, 48% aged 25–29 years, 57% aged 30–39 years, and 65% aged 40 years and older were co-infected. Of MSM aged 15–24 years, 50% of blacks, 21% of Hispanics, 22% of whites, and 25% of other races were co-infected. Considering only MSM aged 15–19 years, 33% of blacks were co-infected (compared to 16% of Hispanics, 11% of whites, and 15% of other races). Conclusions: The most current national surveillance data available indicate that, among individuals reported with P&S syphilis, co-infection with HIV is common across the U.S., even among young (e.g., 15–19 years) MSM. These findings reinforce the recommendation that anyone diagnosed with syphilis be tested for HIV. A diagnosis of P&S syphilis provides an opportunity to ensure that individuals infected with HIV are linked to care, and that the sexual contacts of co-infected individuals are tested for both syphilis and HIV, linked to care, and treated, if appropriate. Efforts to prevent HIV and syphilis must target younger populations before they become infected. 840 Risk Factors for Asymptomatic and Symptomatic Neurosyphilis Differ in HIV-Infected Patients With Syphilis Christina Marra ;Trudy Jones; Shelia Dunaway; Emily Ho; Abigail Crooks; LaurenTantalo; Sharon Sahi University of Washington, Seattle, WA, US Background: Syphilis is common in HIV. Neurosyphilis (NS) is a serious complication of syphilis that can be asymptomatic (asx) or symptomatic (sx). Previous studies have examined risk factors for NS in HIV, but not separately for asx vs. sx NS. Methods: 531 HIV-infected patients with syphilis underwent standardized history and neurological examination, lumbar puncture (LP) and blood draw. 392 (74%) had no NS (no NS symptoms and signs, CSF white blood cells (WBC) ≤ 20/ul, CSF-Venereal Disease Research Laboratory (VDRL) nonreactive), 54 (10%) had asx NS (no NS symptoms and signs, CSF WBC >20/ul or CSF-VDRL reactive), and 85 (16%) had sx NS (NS symptoms and signs). The impact of demographic and clinical measures on asx and sx NS risk was expressed as odds ratios (OR, 95% confidence intervals [95% CI]) using logistic regression. Results: Patients were mainly white (81%) men (99%); 78% had early syphilis, 44% underwent LP a median of 8 (IQR 5-16) days after treatment for current syphilis and 26% had a prior episode of syphilis. Median CSF WBCs were 4 (2-7) for no NS, 29 (17-51) for asx NS and 24 (7-50) for sx NS; CSF-VDRL was reactive in 59% of asx NS and 47% of sx NS; 29% of sx NS did not have CSF abnormalities. Sx NS included vision loss (n=52), hearing loss (n=37), symptomatic meningitis (n=43) and stroke (n=1, also with symptomatic meningitis). Age and CD4 ≤ 350 cells/ul did not affect the ORs for asx or sx NS, while higher serum rapid plasma regain (RPR) titer and no current use of antiretrovirals (ARVs) increased the odds of both. Late syphilis increased the odds of asx but not sx NS, and both treatment for the current episode of syphilis, and a previous episode of syphilis decreased the odds of sx NS but not asx NS (Table). In multivariate analysis, the odds of asx and sx NS remained higher in those with higher RPR titers and no ARV use. Late syphilis was an independent risk for asx but not sx NS, and previous syphilis treatment conferred decreased risk for sx, but not asx NS (Table).

Poster Abstracts

1, per 2-fold increase in titer; 2, early stage includes primary, secondary and early latent syphilis, late stage includes late latent syphilis and syphilis of unknown duration; 3, treatment for current episode of syphilis before LP; 4, an episode of syphilis before the current episode. NS, P>0.05; *P<0.05, **P<0.01; *** P<0.001 Conclusions: HIV-infected individuals with syphilis with higher serum RPR titers and who are not currently taking ARVs have an increased risk of asx and sx NS. In contrast, syphilis stage, previous syphilis treatment, and a previous episode of syphilis differentially affect the risk of asx and sx NS. Our findings can assist clinicians in choosing which HIV-infected syphilis patients would benefit the most from CSF examination.

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CROI 2015