CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Results: 60 patients were included (28 doxycycline, 32 PAzR), all MSM, 95% HIV-positive, 85% receiving ART, 75% showing plasma HIV RNA below detection, 25% simultaneously diagnosed with other STDs. Average time between onset of symptoms and diagnosis was 39 days (1-180). Two patients in the DoxLGV group and one in PAzR were lost to follow-up. Patients who correctly completed doxycycline (n=27, 96%) and PAzR (n=30, 94%) all clinically responded. All patients but one in the PAzR group became negative for the M-PCR- LGV during the regimen. The one asymptomatic patient with persistent M-PCR for LGV at day +28 became negative after DoxLGV treatment. No treatment-related adverse events were reported. Conclusions: Our findings show that an extended but simple azithromycin regimen (PAzR) was as effective as standard doxycycline (DoxLGV) and may be considered for successful treatment of LGV in an HIV-infected population. 846 Risk Factors for Staphylococcus Aureus Carriage in HIV-Infected Adults in Southern Botswana Michael J. Reid 1 ; Rebceca Fischer 3 ; Naledi Mannathoko 2 ; Eric Brown 3 ; Andrew Steenhoff 4 1 University of California San Francisco, San Francisco, CA, US; 2 University of Botswana, School of Medicine, Gaborone, Botswana; 3 University of Texas, Texas, Afghanistan; 4 University of Pennsylvania, Gaborone, Botswana Background: Despite the huge burden of HIV disease, data describing the prevalence of Staphylococcus aureus nasal carriage in the setting of HIV infection in southern Africa are sparse. Methods: This cross-sectional study sought to estimate the prevalence of S. aureus nasal carriage and define risk factors for colonization among HIV-infected individuals in southern Botswana. 418 HIV-infected individuals (116 men, 302 women) were screened twice for nasal carriage of methicillin-susceptible (MSSA) and methicillin resistant (MRSA) S. aureus over a 4-week interval at two outpatient facilities. S. aureus carriage was further defined as either intermittent (carriage at one visit but not both) or persistent (carriage at both visits). Nasal carriage was related to demographic characteristics, HIV parameters, co-morbidities, and exposure to health care services. Results: Prevalence of nasal colonization for S. aureus was 38% (n=158); 49% (n=78) were intermittent carriers, 51% (n=80) persistent carriers. Prevalence of intermittent MRSA carriage was 3% (n=13); no patients were persistently colonized by MRSA. Those > 18 years were less likely to be persistent carriers than those < 18 years (Prevalence Ratio [PR] 0.41, p=0.003). Those accessing care at a semi-rural facility (PR 2.19, p=0.005), sharing households with ≥ 1 child (PR 1.36, p=0.06) and those with elevated viral loads (>399 copies/mL) (PR 1.88, P=0.019) were also more likely to be persistent carriers than non-carriers. Those with MRSA were more likely to be <18 years old (PR 0.12, p<0.05) and have history of eczema (PR 5.72, p=0.001), asthma (PR 3.75, p<0.05), tuberculosis (PR 3.26, p=0.03), or pneumonia (PR 3.6, p=0.03). Neither MSSA nor MRSA was significantly associated with viral load or CD4 count. However, MRSA was more prevalent than MSSA among those on third line (PR 4.52, p=0.08) antiretroviral regimes and those with detectable viral loads (PR 1.67, p=0.052). Conclusions: HIV-infected children, persistent viremia and those living in semi-rural and larger households constitute high-risk groups for nasal carriage for S. aureus. Intermittent MRSA carriage was more prevalent among younger patients with unsuppressed viremia and co-morbid diseases. Persistent nasal MRSA colonization among non- hospitalized HIV-infected persons was neglible 847 Specific Behaviors Predict Staphylococcus aureus Colonization and Skin and Soft Tissue Infections Among HIV-Infected Persons Nancy Crum-Cianflone ; XunWang; AmyWeintrob;Tahaniyat Lalani; Mary Bavaro; Katrin Mende; Michael Ellis; Brian K. Agan Infectious Disease Clinical Research Program, San Diego, CA, US Background: Staphylococcus aureus skin and soft tissue infections (SSTIs) have markedly increased over the past two decades. Few prospective data exist on the incidence rates and risk factors of S. aureus colonization and SSTIs among HIV-infected persons in the HAART era. Methods: We screened 516 HIV-infected adults at three geographically diverse locations. S. aureus colonization was examined at five specific body sites (nares, throat, axilla, perirectal and groin). After excluding those colonized at baseline (n=161) or lost to follow-up (n=33), 322 participants were prospectively evaluated over a 2-year period for incident colonization and SSTIs. Study visits occurred every 6 months and included multiple sociodemographic, behavioral, clinical, and laboratory measures. Separate Cox proportional hazard models with time-updated covariates assessed the predictors of S.aureus colonization and SSTIs. Results: 322 participants had a median age of 42 years (IQR 32-49), median duration of HIV of 9.4 years (2.7-17.4), and 58%were receiving HAART. Overall, 102 (32%) became colonized with S. aureus with an incidence rate of 206 (95% CI 168-250) per 1000 PYs. Predictors of S. aureus colonization in the final multivariate model included illicit drug use (HR 4.26, 95% CI 1.33-13.69) and public gym use (HR 1.66, 95% CI 1.04-2.66), while antibacterial soap use was protective (HR 0.5, 95% CI 0.32-0.78). Overall, 14% developed an SSTI [incidence rate of 94 cases (95% CI 68-127)/1000 PYs]. Risk factors for developing an SSTI in the time-updated unadjusted Cox models included incident S. aureus colonization, illicit drug use, tattoo receipt, public shower use, public gym use, and hospitalization in the last six months. In the final multivariate model, S. aureus colonization (HR 2.52, 95% CI 1.35-4.69), public shower use (HR 2.59, 95% CI 1.48-4.56), and hospitalization in the last six months (HR 3.54, 95% CI 1.67-7.53) predicted SSTIs. HIV-related factors (history of AIDS, CD4 count, viral load, and HAART use), sexual behaviors, and owning a pet were not predictive of incident colonization or SSTIs. Conclusions: HIV-infected adults have a high incidence of S. aureus colonization and SSTIs. Specific behaviors, but not HIV-related factors, were predictors of colonization and SSTIs in our study. These data suggest that behavioral modifications may be the most important strategies in preventing S. aureus colonization and SSTIs among HIV-infected persons. 848 Cytokine Profile in Aqueous Humor of HIV Patients With Ocular Opportunistic Infections Matilde Ruiz-Cruz ; Santiago Avila-Rios; Christopher Ormsby; Claudia Alvarado-de la Barrera;Yuria Ablanedo-Terrazas; Gustavo Reyes-Terán National Institute of Respiratory Diseases, Mexico City, Mexico Background: Opportunistic ocular infections (OI) are commonly associated with HIV infection. Immunologic factor profiles in aqueous humor (AqH) in different OI in the context of HIV infection are yet to be elucidated. We determined the cytokine and chemokine profiles in AqH and plasma of HIV-infected individuals with OI, before and after specific treatment. Methods: OI diagnoses and post-treatment assessments were performed in 46 HIV-infected individuals, including 23 patients with cytomegalovirus retinitis (CMVr), 16 with ocular syphilis and 7 with other OI. As control groups, plasma from 15 healthy donors and AqH from 16 patients undergoing cataract surgery were included. Concentrations of 27 cytokines in AqH and plasma before and after OI treatment were assessed using a multiplex assay. Cytokine concentrations in AqH and plasma were compared between different OI and between HIV-infected individuals and controls, using Wilcoxon tests corrected for multiple comparisons. Statistical analysis was carried out using R software version 3.0.2 Results: Characteristic cytokine profiles were observed in AqH of CMVr and ocular syphilis with higher levels of GM-CSF, IL-1 α and IP-10 in CMVr (p<0.03). After treatment of CMVr, a significant reduction in the concentration of AqH proinflammatory cytokines (IFN-2 α , IL1 α , IL-6, TNF α , and IFN- γ ; p <0.003), chemokines (eotaxin, IL-8, MCP-1, MIP-1 α , MIP-1 β , and IP-10; p <0.0005), and growth factors (G-CSF and GM-CSF; p <0.0001) was observed. Additionally, a significant reduction ( p <0.002) in IL-10 plasma concentrations was observed. After treatment of ocular syphilis, we observed a significant reduction in AqH concentrations of proinflammatory cytokines (IL-1 α and IL-6; p <0.014), chemokines

Poster Abstracts

512

CROI 2015