CROI 2015 Program and Abstracts

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Poster Abstracts

Results: An HIV test was performed at 4,215,610 visits (0.70%). Women were tested at 2,891,640 visits (0.77%) and men at 1,323,970 (0.58%). As age increased, we found a decreasing trend in HIV testing with testing at 2,299,870 (1.9%) visits by persons aged 15-29 year and 305,170 (0.12%) at visits by those aged 50-65 years (p<0.001). Testing was performed at a larger proportion of visits by black (1,200,200 (1.7%)) (p<0.001) or Hispanic (786,080 (1.2%)) (p<0.001) than white persons (2,056,850 (0.46%)); by persons with Medicaid (876,450 (1.4%)) than private insurance (2,685,300 (0.65%)) (p=0.031); and to primary care providers (3,672,610 (1.1%)) than specialists (543,000 (0.20%)) (p<0.001). HIV testing occurred more frequently at preventive visits (2,482,170 (2.1%)) than other visits (1,710,200 (0.36%)) (p<0.001). Persons who had a visit with symptoms were not tested more frequently. If a blood draw was ordered at a visit, an HIV test was performed more frequently (3,131,580 (2.4%)) compared to a visit without a blood draw (1,084,020 (0.23%)) (p<0.001). Conclusions: HIV testing was performed at only a small proportion of visits to physicians. Many testing opportunities were missed, including during preventive visits, symptomatic visits, and visits where other laboratory testing of blood was ordered. Increased awareness of the recommendation for universal testing, and implementation of structural interventions to facilitate HIV testing along with other laboratory testing, might increase testing coverage. 1083 Frontline Practices With HIV Prevention: A Survey of US Infectious Disease Physicians Douglas S. Krakower 1 ; Susan E. Beekmann 2 ; Philip M. Polgreen 2 ; Kenneth H. Mayer 1 Emerging Infections Network 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US; 2 University of Iowa, Iowa City, IA, US Background: Early initiation of antiretroviral therapy (early ART) for HIV+ patients (pts) and preexposure prophylaxis (PrEP) for at-risk, HIV(-) persons decreases HIV transmission, but little is known about how clinicians implement these strategies. The Emerging Infections Network (EIN), a national network of infectious diseases (ID) physicians, was surveyed in September 2014 to assess practices with early ART, PrEP and other HIV prevention methods. Methods: An online survey of members assessed intentions and practices with early ART, PrEP, and risk reduction counseling. Analyses were restricted to HIV providers (i.e., treat ≥ 1 HIV+ patient/year). Chi-square tests measured associations between categorical variables. Results: Almost half (47%) of 1198 members completed surveys; 73%were HIV providers. The sample was regionally diverse; 63% practiced at teaching hospitals, 53% had ≥ 15 years ID experience and 42% treated > 50 HIV+ pts/year. Most providers (87%) said they recommended ART initiation at diagnosis irrespective of CD4 count. However, for pts with CD4 > 500 cells/ μ L, clinicians would defer ART if a patient was not ready to initiate (97%) or has untreated depression/psychiatric illness (47%) or substance abuse disorder (68%), or if resources for ART/HIV care are limited (50%). For HIV serodifferent couples (SDC), 59% of providers had counseled HIV+ pts about PrEP for partners, 41% had offered visits for partners to discuss PrEP, and 32% had prescribed PrEP. Physicians recommended PrEP when the HIV+ partner is viremic (79%) or aviremic on ART (35%). Respondents supported offering sterile syringes (80%), opiate substitution therapy (68%), and PrEP (42%) to persons injecting drugs, but few felt prepared to provide these (10%, 7% and 26%). Most physicians (78%) provided risk reduction counseling to > 90% of pts newly diagnosed with HIV, yet only 30% did so for established pts. Those with higher volumes of HIV+ pts were more likely to have provided interventions to SDC, including counseling, offering visits to HIV(-) partners, and prescribing PrEP ( P <.0001). Conclusions: ID physicians almost universally recommend early ART, and many have adopted aspects of PrEP provision into practice. However, clinicians may defer ART based on patient readiness or psychosocial factors, and only 1/3 of providers have prescribed PrEP. Interventions that help physicians motivate pts to start ART, identify and overcome missed opportunities to provide PrEP, and routinely deliver risk reduction counseling are needed. 2:30 pm– 4:00 pm Male Circumcision: Risk, Innovation, and Scale-Up 1084 HSV-2 Shedding FromMale CircumcisionWounds Among HIV-Infected Men Mary K. Grabowski 1 ; Godfrey Kigozi 2 ; Ronald H. Gray 1 ; Jordyn L. Manucci 3 ; David Serwadda 4 ; Eshan U. Patel 3 ; Fred Nalugoda 2 ; Maria J.Wawer 1 ;Thomas C. Quinn 5 ; Aaron A.Tobian 3 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US; 2 Rakai Health Sciences Program, Kalisizo, Uganda; 3 Johns Hopkins University School of Medicine, Baltimore, MD, US; 4 Makerere University College of Health Sciences, Kampala, Uganda; 5 National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, MD, US Background: A randomized trial showed that although medical male circumcision (MMC) reduces herpes simplex virus type 2 (HSV-2) acquisition among men, MMC had no impact on HSV-2 transmission to female partners. We conducted a prospective observational study in Rakai, Uganda to assess HSV-2 shedding post-MMC. Methods: HSV-2 shedding was evaluated among 176 HIV and HSV-2 co-infected men (145 self-reported antiretroviral therapy (ART)-naïve, 9 self-reported ART use with detectable plasma viral load (VL), and 22 self-reported ART with undetectable plasma VL of <400 copies/mL). All men underwent dorsal slit MMC. HSV-2 serostatus was determined by an HSV-2 ELISA (Kalon Biological Ltd, Guilford, UK) with positive serology defined as an optical density index value ≥ 1.5. Preoperative and weekly penile lavages for 6 weeks were tested for HSV-2 shedding and viral load using a real-time quantitative PCR assay with primers to glycoprotein B. HSV-2 shedding was defined as >50 copies of HSV-2 DNA/mL on two separate runs. Prevalence risk ratios (PRRs) and 95%CI were estimated using Poisson regression with generalized estimating equations and robust variance. Results: HSV-2 shedding was detected in 9.7% (17/176) of men prior to MMC. There was a non-significant increase in the proportion of men with post-MMC HSV-2 shedding relative to baseline at weeks one (12.9%, 22/170, PRR=1.33, 95%CI=0.74-2.38, p=0.329) and two (14.8%, 23/155, PRR=1.50, 95%CI=0.86-2.38, p=0.153). HSV-2 shedding returned to baseline levels by week six after MMC (6.9%, 10/144, PRR=0.71, 95%CI=0.36-1.41, p=0.330). Post-operative HSV-2 shedding did not differ significantly between men who reported ART use compared to those who did not report ART use (PRR=0.67, 95%CI=0.24-1.80). HSV-2 shedding was lower among men with MMC wounds that were certified as healed (PRR=0.61, 95%CI=0.36-1.06, p=0.082). Among men with detectable HSV-2 shedding, the median HSV-2 log 10 VL/mL was elevated at week one (median=3.2, IQR=2.2- 4.8) compared to baseline (median=2.3, IQR=1.8-2.9), though this difference was not statistically significant (p=0.09.) Levels of HSV-2 among men with detectable shedding were similar to baseline at all other post-operative visits. Conclusions: Penile HSV-2 shedding was non-significantly increased during the first two weeks after MMC. Men undergoing MMC should be counseled on sexual abstinence until wound healing and consistent condom use thereafter. THURSDAY, FEBRUARY 26, 2015 Session P-Y1 Poster Session Poster Hall

Poster Abstracts

632

CROI 2015