CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

TUESDAY, FEBRUARY 24, 2015 Session P-S2 Poster Session

Poster Hall

2:30 pm– 4:00 pm Cervical Sampling, Shedding, and Outcomes 855 Symptoms and Genital HSV-2 and HIV-1 in CoinfectedWomen, Chiang Rai, Thailand Eileen F. Dunne 1 ; Brooke E. Hoots 1 ; Janet McNicholl 1 ; SaraWhitehead 2 ;Thomas A. Peterman 2 ; Lauri E. Markowitz 2 ;Wanna Leelawiwat 3 ;Tammy Evans-Strickfaden 1 ; Cheng Chen 1 1 US Centers for Disease Control and Prevention, Bangkok, Thailand; 2 US Centers for Disease Control and Prevention, Atlanta, GA, US; 3 Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand Background: There are few studies examining daily HIV-1 and HSV-2 shedding in HIV-1 and HSV-2 co-infected women. We examined the association between daily genital HSV symptoms and daily HSV-2 and HIV-1 genital shedding. Methods: Sixty-seven Thai women participating in the placebo arm of a randomized, crossover placebo-controlled trial of the effect of acyclovir on HIV-1 shedding provided daily information on genital symptoms (genital sores and other symptoms self-reported on daily diary cards). Eligible women were aged 18–49 years, had regular or no menses, had serum antibodies to HSV-2 and HIV-1, and were not eligible for antiretroviral therapy by Thai national guidelines at the time. Women self-collected genital swabs of the vaginal, vulvar and perianal region, inserted the swabs into a sponge with DNA/RNA preservative, and kept the tubes in a cooler until weekly collection. Nucleic acid extraction of both HIV-1 RNA and HSV-2 DNA were conducted and specimens with detectable virus were quantified. Associations between shedding and patient characteristics were evaluated using binomial regression with generalized estimating equations with an exchangeable correlation matrix to account for non-independence of swabs collected from the same woman. Results: During the study, 20 (30%) participants reported burning, itching, tingling, or pain in any area on at least one day and 23 (35%) reported a sore on at least one day during the month. Of 561 swabs tested for HSV-2 DNA, 27% had detectable virus and of 525 swabs tested for HIV-1 RNA, 71% had detectable virus. Most shedding occurred in the absence of sores or symptoms (77% of swabs with detectable HSV-2 and 86% of swabs with detectable HIV-1). However, compared to swabs fromwomen with no symptoms or sores, swabs fromwomen with symptoms in the three-day window before collection were 2.0 (95% CI: 1.2-3.3) times as likely to be positive for HSV-2 DNA, and swabs fromwomen with sores were 2.7 (95% CI: 1.6-4.4) times as likely to be positive. Neither symptoms nor sores reported in a three-day window prior to swab collection were associated with HIV shedding. Conclusions: While HSV-2 shedding was more likely to occur following symptoms and sores, HIV-1 shedding was not; this difference in shedding suggests that HIV-1 shedding may be unrelated to HSV-2 mediated mucosal events. Our study found that most HSV-2 as well as HIV-1 genital shedding occurred primarily during days when there were no clinical symptoms. 856 High-Risk HPV Clustering and Cervical Outcomes in HIV-InfectedWomen in Rio de Janeiro, Brazil Jessica L. Castilho 1 ; José Eduardo Levi 2 ; Paula M. Luz 2 ; Mary Catherine Cambou 3 ;TazioVanni 4 ; Angela de Andrade 2 ; Monica Derrico 2 ;ValdileaVeloso 2 ; Beatriz Grinsztejn 2 ; Ruth Friedman 2 1 Vanderbilt University School of Medicine, Nashville, TN, US; 2 Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; 3 University of California Los Angeles, Los Angeles, CA, US; 4 United Nations, Lyons, France Background: In Brazil, rates of HPV infection and cervical cancer remain high. With ongoing vaccine development, information of specific HPV type prevalence, particularly among HIV-infected women, is needed. Methods: We performed a cross-sectional study of HIV-infected women in Rio de Janeiro, Brazil, who underwent cervical HPV genotype testing between 2006-2013. We examined the prevalence of HPV types and the patterns of high risk HPV type clustering. Using logarithmic binomial regression, we estimated the risk of abnormal cytology by HPV genotype result, adjusting for patient factors. Results: Of the 562 women included, 364 women (65%) had at least one high risk HPV type detected, and 181 (32%) had more than one high risk type detected. Overall, HPV 58 was the most frequent HPV type detected (prevalence 19.8% [95% confidence interval 16.4-23.1]); HPV 16 was the second most frequent high risk type (prevalence 13% [10.2-15.8]). Prevalence of high risk HPV types by cytology outcome are shown in the Figure. Women infected with more than one high risk HPV type were younger, had lower CD4+ lymphocyte counts, were more likely to be infected with HPV 16 or 18, and were more likely to have abnormal cytology. There was no difference in duration of antiretroviral therapy by HPV genotype result. Among women with abnormal cytology, individual high risk HPV clustering patterns were diverse and without a predominant high risk pair (the most frequent pair, HPV 31 and 58, occurred in only 6% of cases). While many high risk HPV types were associated with abnormal cytology in univariate analyses, none remained statistically significant in models adjusting for presence of more than one high risk type, age, and CD4+ lymphocyte count. In multivariate models, presence of more than one high risk type was associated with a two-fold increased risk of abnormal cytology in every model (adjusted prevalence ratios [aPRs] 1.88-2.07, all p values <0.001). CD4+ lymphocyte count also remained statistically significant in every model (aPRs 0.91-0.92 per 100 cells/mL increase, all p values 0.001).

Poster Abstracts

516

CROI 2015