CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Methods: Cross-sectional study within the Spanish National Cohort of Vertically HIV-infected children (CoRISpe). Perinatally HIV-HVC co-infected children, adolescents and young adults with longitudinal follow-up data were included. Epidemiological, clinical and treatment related variables were analyzed. Results: The study included 50 HIV/HVC co-infected patients from 16 different hospitals, 34 (68%) of them already transferred to adult units at the moment of inclusion. Mean age was 20 ± 4.5 years, 56% female, 14% of subjects with a prior AIDS diagnosis. All but three were on ART, but only 88% had HIV-RNA <50 cop/mL. Median CD4 T-cell count was 788 cel/mm[516-980], CD4/CD8 ratio 0.77[0.5-1.2] and CD4 nadir 218 cel/mm[119-389]. Regarding HVC diagnosis, 66% corresponded to genotype 1, 21% to genotype 4, 11% to genotype 3 and 2% to genotype 2. Transient elastometry data (Fibroscan) were available for 40 patients; of them, 22 (55%) showed liver fibrosis stage F1, 9 (25%) F2, 3 (7.5%) F3 and 5 (12.5%) F4. Progression to F3 occurred at a median age of 18 years[14-19]. Only 15 patients had received treatment for HVC infection, at a median age of 17.4 years[14.8- 19.4]. Nine of them corresponded to genotype 1, 3 to genotype 3 and 3 to genotype 4. Treatment reached sustained viral response only in 5 patients (33.3%), three had genotipe1 and 2 genotype 3, one of them after being retreated. Of treated patients, 4 had been diagnosed of liver fibrosis stage F1-F2 and one F3. Most treatment combinations included peg-interferon plus ribavirine. Only in two cases treatment included telaprevir and only one of themwas successful. Two cases received non-pegilated interferon, alone or in combination with ribavirine, and both failed to reach sustained viral response. Conclusions: Our results suggest that HVC co-infection in vertically HIV-infected patients progress slowly during childhood, and most patients reach adult units without liver fibrosis. However, approximately 20% of children progress to liver fibrosis, most of them at the end of adolescence. Rates of sustained viral response were very low in this unique cohort, arousing the need of new therapeutic approaches for this population. 943 Human Papillomavirus and Cervical Cytology in Perinatally Infected Asian Adolescents Annette H. Sohn 1 ; Stephen J. Kerr 2 ; Rawiwan Hansudewechakul 3 ;Wasana Prasitsuebsai 2 ; Kulkanya Chokephaibulkit 4 ;TruongV. Nguyen 5 ;Thoa P. Le 6 ;Thida Singtoroj 1 ; Nittaya Phanuphak 7 ; HPV in Adolescents Study 1 1 TREAT Asia/amfAR – The Foundation for AIDS Research, Bangkok, Thailand; 2 HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; 3 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; 4 Siriraj Hospital, Mahidol University, Bangkok, Thailand; 5 Hung Vuong Hospital, Ho Chi Minh City, Viet Nam; 6 Children’s Hospital 1, Ho Chi Minh City, Viet Nam; 7 SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand Background: Persistent human papillomavirus (HPV) infection is the cause of multiple cancers, and associated with HIV infection. The risks may be higher in perinatally infected (paHIV) versus HIV-negative (HIV-neg) adolescents because of long-standing immune deficiency. We compared the prevalence of HPV infection and cervical cytology abnormalities in a case-control study in Asia. Methods: Available baseline data from female participants enrolled up to July 2014 from 5 centers in Thailand and Vietnamwere included in this analysis. paHIV and HIV-neg females were matched by age and lifetime number of sexual partners. HPV genotyping was performed on cervical, anal, and oral samples using the LINEAR ARRAY test (Roche). Liquid-based cervical cytology was interpreted using 2001 Bethesda criteria. Between-group comparisons of proportions were made using a chi-square or Fisher’s exact test. Results: A total of 90 paHIV and 70 HIV-neg sexually active females with a median age of 18 (IQR 18-20) years were enrolled. The median number of partners in the previous 6 months was 1.0 (IQR 1–1), and the median lifetime partners was 2 (IQR 1–3) in both groups; 2 females in each group reported a history of receptive anal intercourse. In paHIV, the median CD4 cell count was 567 (IQR 358-765) cells/mm 3 and 57 (63%) had HIV-RNA <40 copies/mL; 81 were currently on antiretroviral therapy. The prevalence of any high-risk HPV infection in paHIV and HIV-neg was 40% vs. 30% (p=0.19) in cervical, 42% vs. 23% (p=0.01) in anal, and 6% vs. 4% (p=0.73) in oral samples. The most common high-risk HPV type in cervical samples among paHIV was HPV 16 (14% vs. 7% in HIV-neg; p=0.15); 26 (29%) paHIV and 13 (19%) HIV-neg had partially or completely concordant high-risk HPV in cervical and anal compartments (p=0.17). The prevalence was 17% vs. 1.5% for low-grade squamous intraepithelial lesion (LSIL), and 1.1% vs. 1.5% for high-grade SIL (HSIL) in paHIV vs. HIV-neg females. Compared to HIV-neg females, paHIV had higher prevalence of abnormal cervical cytology from low-grade squamous intraepithelial lesion (LSIL) and above (p=0.004). Conclusions: paHIV females had a higher prevalence of LSIL+ than HIV-neg females. Anal high-risk HPV infection was common despite infrequently reported anal intercourse, which may be explained by concordant cervical and anal HPV infection. paHIV should be prioritized for HPV vaccination, whenever available. 944 Sexually Transmitted Infections in YouthWith Controlled and Uncontrolled HIV Andres F. Camacho-Gonzalez 1 ; Miriam C. Chernoff 2 ; Paige L.Williams 2 ; Ann Chahroudi 1 ; James M. Oleske 3 ; Rana Chakraborty 1 ; ShirleyTraite 2 ; Murli U. Purswani 4 ; Mark J. Abzug 5 On behalf of the IMPAACT P1074 StudyTeam 1 Emory University School of Medicine, Atlanta, GA, US; 2 Harvard School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA, US; 3 Rutgers New Jersey Medical School, Newark, NJ, US; 4 Albert Einstein College of Medicine, Division of Pediatric Infectious Diseases, Bronx Lebanon Hospital Center, Bronx, NY, US; 5 University of Colorado School of Medicine, Division of Pediatric Infectious Diseases, Aurora, CO, US; 6 International Maternal Pediatric Adolescent AIDS Clinical Trials, Durham, NC, US Background: Half of new sexually transmitted infections (STIs) and 26% of new HIV infections each year in the US occur in youth 13-24 years of age. Co-STIs are a risk factor for HIV acquisition and transmission, but there is lack of data on STI acquisition in adolescents and young adults (AYAs) with controlled or uncontrolled HIV infection. Methods: We determined the incidence of STIs in HIV-infected AYAs 12.5-<25 years of age who participated in the IMPAACT P1074 prospective observational cohort study from April 2009-April 2014 and compared rates among individuals with controlled and uncontrolled HIV infection. Virologic and immunologic control was defined as a mean HIV-1 RNA viral load (VL) level of <500 copies/mL and mean CD4+ T-cell count >500 cells/ m l over the year preceding STI diagnosis. Socio-demographic and HIV disease characteristics were summarized by descriptive statistics. Univariate and multivariable logistic regression models were applied to evaluate the association of virological and immunological control on occurrence of STIs and identify other associated risk factors. Results: 1,061 participants met criteria for study participation (49%male, 61% black, and 87% perinatally HIV-infected, with a mean age of 18.4 years at first chart review (SD: 3.9 years)). Ninety-five participants had a history of STI prior to study entry; of the remaining 966, 93 had incident STIs for an incidence rate of 2.59/100 person-years. Human papilloma virus (HPV) and chlamydial infections were the most common STIs. Univariate analysis showed significantly higher risk for an incident STI in AYAs who were older (odds ratio (OR)=1.17), female (OR=2.04), horizontally HIV-infected (OR=3.88), and had a prior STI history (OR=3.48). Significantly higher STI risk was observed with lower mean CD4+ T-cell counts (OR=2.60 for ≤ 500 cells/ m l) and higher mean VL (OR=1.88 for ≥ 500 copies/mL). In the multivariable model, having an incident STI continued to be associated with older age (adjusted OR (aOR)=1.09, p=0.01), female sex (aOR=2.78, p<0.001), horizontally-acquired HIV-infection (aOR=2.08, p=0.02), and mean CD4+ T-cell count ≤ 500 cells/ m l (aOR=2.26, p=0.001), but not with higher VL. Conclusions: Significant rates of new STIs among HIV-infected AYAs demonstrate the need for enhanced preventive interventions, including safe-sex practices and HPV vaccination. STI acquisition is associated with older age, female sex, horizontally acquired HIV infection, and lower CD4+ T-cell count.

Poster Abstracts

564

CROI 2015