CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

626 HPV Type Distribution in HIV-Infected Persons With Anal HSIL and Impact on Recurrence Michael Gaisa 1 ; Keith M. Sigel 1 ; Stephen Goldstone 1 ; Matthew Silverstein 1 ; Iain MacLeod 2 1 Icahn Sch of Med at Mount Sinai, New York, NY, USA; 2 Harvard Sch of PH, Boston, MA, USA Background: Infection of the anal canal by high-risk human papillomavirus (HR-HPV) is associated with high-grade squamous intraepithelial lesions (HSIL), the precursor of anal carcinoma. HPV type distribution in anal HSIL and its potential impact on recurrent lesions following ablation are poorly understood. Methods: 110 intraanal HSILs from 89 HIV-infected patients were analyzed. Probe-based qPCR was used to detect HR-HPV types 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68 from genomic DNA extracted from biopsy specimens. HSIL was treated using electrocautery ablation (EA) and surveillance biopsies of suspicious lesions were obtained during follow-up evaluations. Clinical data were abstracted from a longitudinal database. Results: 71 (80%) patients were men who have sex with men (MSM), 16 (18%) women and 2 (2%) heterosexual men (HM). 66 patients (74%) had moderate and 23 (26%) had severe dysplasia. 16% of biopsies had no HPV detected from the selected panel of 15 high-risk types; 58% had a single HPV type, 19% had two types, and 7% had ≥3 HPV types. HPV16 was the most prevalent HPV type detected in 38% of samples, followed by HPV33 (12%), HPV35 (9%) and HPV39 (8%). HPV18 was present in only 3% and HPV26 was not detected in any sample. Anal infection with >1 HPV type was present in 16 patients (24%) with moderate and in 12 (52%) with severe dysplasia (p=0.01). Women were more likely to be concomitantly infected with >1 HR-HPV type (56%) than MSM (27%) and HM (0%; p=0.04). Neither CD4 T-cell count, smoking history, receptive anal sex nor age were significantly associated with infection by multiple HR-HPV types. There was low correlation between HR-HPV types present in separate lesions in patients with multiple HSILs (R=0.01). Surveillance biopsies were obtained in 52 patients within a median follow-up of 29 months (IQR 19-35). 43% had recurrent HSIL and 57% had low grade or no dysplasia on follow- up. Recurrent HSIL did not correlate significantly with number or type of HR-HPV on initial biopsy. Conclusions: Anal HSIL contains a wide range of HR-HPV types and presence of multiple types per lesion is common. HPV16 was most prevalent and infection with >1 HR-HPV type was associated with more severe dysplasia. The risk of developing recurrent HSIL following EA is high and not associated with number or type of HR-HPV on initial biopsy. 627 Multiple HPV Genotypes As a Risk Factor for High Grade AIN in HIV-1 Infected Males Cristina Rovelli 1 ; Andrea Poli 2 ; Massimo Cernuschi 3 ; Andrea MarcoTamburini 3 ; Sara Racca 3 ; Laura Galli 3 ; GiuseppeTambussi 3 ; Antonella Castagna 3 ; Adriano Lazzarin 4 ; Silvia Nozza 3 1 Università Vita-Salute San Raffaele, Milano, Italy; 2 Università Vita-Salute San Raffaele, Milan, Italy; 3 San Raffaele Scientific Inst, Milan, Italy; 4 Vita-Salute Univ, San Raffaele Scientific Inst, Milan, Italy Background: HIV-infected patients (pts) have an increased risk for HPV infection and related lesions. Objectives of the study were to determine prevalence of high grade anal intraepithelial neoplasia, high risk HPV (HR-HPV) genotypes and to identify factors associated with a high grade anal intraepithelial neoplasia in a cohort of HIV-infected males. Methods: Cross-sectional study on HIV-infected pts followed at the Department of Infectious Diseases of San Raffaele Scientific Institute with HPV screening performed in absence of clinical symptoms. We considered in the analysis pts who were tested for multiple HPV genotypes (Abbott Real Time High Risk HPV DNA). The presence of oncogenic HPV genotypes (16,18,31,33,35,39,45,51,52,56,58,59,66,68) classified pts as having HR-HPV. Pts were categorized according to the cytological findings (AIN): no (AIN=0)/low (AIN=1) Results: 669 pts were screened and in 273/669 pts data on multiple oncogenic HPV type were available and were considered in the analyses. Pts’ characteristics at HPV screening were: age 43.9(37.8-50.1) years, 75%MSM, HIV diagnosis since 9.6(3.7-17.3) years, 50%with previous syphilis, CD4+ 611(470-787) cells/µL, CD4+/CD8+ 0.62(0.42-0.93), 97% pts were treated with antiretroviral therapy (ART) since 7.2(1.8-14.1) years, 75% had HIV-RNA<50 cps/mL. Eighteen (7%) pts had HG-AIN; 111 (41%) pts had HR-HPV infection: HPV-16 was found in 75 (32%) pts and HPV-18 in 47 (20%) pts. Both HPV types were more frequent among pts with HG-AIN [HPV-16: 72% vs 29% in HG-AIN and LG-AIN, respectively (p<0.0001); HPV-18: 44% vs 18% in HG-AIN and LG-AIN, respectively (p=0.013)]. Seventy-one pts (26%) had multiple HPV genotypes. HG-AIN was more frequent among pts with multiple HR-HPV types (≥2) rather than pts with 0-1 genotypes [12 (17%) vs 6 (3%), p<0.0001]. At multivariate logistic regression (Figure 1) we found that pts with a lower CD4+/CD8+ ratio, ≥2 HR-HPV genotypes and longer ART duration were more likely to have HG-AIN. Conclusions: Infection with multiple strains of HR-HPV is a risk factor for HG-AIN, in addition to CD4+/CD8+ ratio and years of ART. These features suggest that the identification of HPV genotypes over time might improve prevention of HPV-related neoplasms. grade of anal intraepithelial neoplasia (LG-AIN) or high (AIN=2-3) grade anal intraepithelial neoplasia (HG-AIN). Results were described with median (IQR) or frequency (%). Logistic regression was used to identify risk factors for HG-AIN.

Poster Abstracts

628 Prevalence of HPV-Related Lesions in an Urban Cohort of HIV-Positive Men in Germany Wolfgang Fuchs 1 ; UlrikeWieland 2 ; Adriane Skaletz-Rorowski 3 ; Jochen Swoboda 4 ; Alexander Kreuter 5 ; Claudia Michalik 6 ; Anja Potthoff 7 ; Norbert H. Brockmeyer 1 ; for the Competence Network for HIV/AIDS 1 Clinic for Dermatology, Ruhr-Universität Bochum, Germany, Bochum, Germany; 2 Natl Reference Cntr for Papilloma- and Polyomaviruses, Univ of Cologne, Cologne, Germany; 3 Competence Network for HIV/AIDS, Ruhr-Universität, Bochum, Germany; 4 Inst of Cytology, Bonn, Germany; 5 Helios St. Elisabeth Hosp Oberhausen, Oberhausen, Germany; 6 KompNet HIV/AIDS, Bochum, Germany; 7 Fachklinikum Borkum, Borkum, Germany Background: Human papillomaviruses (HPV) induce condylomata, anogenital cancers and their precursor lesions as anal or penile intraepithelial neoplasia (AIN/PIN). HIV-positive individuals have an increased risk for the development of anogenital HPV-induced lesions. The aim of the male ScreenING-Study was to evaluate the prevalence of genital and anal condylomata, intraepithelial neoplasia, anal and penile cancer, and related HPV-types in HIV-infected men at the Interdisciplinary Immunological Outpatient Clinic of the Department of Dermatology of the St. Josef Hospital, Ruhr-University Bochum.

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