CROI 2016 Abstract eBook

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Poster Abstracts

Results: 186 (97%) participants were male and 159 (83%) were HIV-infected. Median (IQR) age was 37 (32-43) years and median serum RPR titer was 1:64 (1:32-1:256). 134 (70%) had early syphilis, 61 (32%) had a reactive CSF-VDRL, 69 (36%) had >20 WBCs/ul CSF and 40 (22%) of 183 without pre-existing abnormalities had vision or hearing loss. CSF FTA-ABS was reactive in 94 (49%), CSF-TPPA was reactive in 103 (54%), and CSF-TPPA was ≥1:320 in 58 (30%). Agreement between CSF-FTA-ABS and CSF-TPPA was good (kappa=0.68). Sensitivities and specificities of CSF-FTA-ABS for laboratory and clinical definitions of neurosyphilis were higher than for CSF-TPPA, but these differences were not statistically significant. For clinically defined neurosyphilis, sensitivities of CSF-FTA-ABS and CSF-TPPA were significantly higher than for CSF-VDRL (P=0.0006 and P<0.0001). The specificity and sensitivity of a CSF-TPPA titer ≥1:320 did not differ significantly from CSF-VDRL (Table). Conclusions: In our study sample, the NS diagnostic performance of the CSF-TPPA is similar to the CSF-FTA-ABS test, and CSF-TPPA ≥1:320 can rule-in the diagnosis of NS. These results should be independently replicated.

768 Invasive Pneumococcal Disease Among HIV-Infected Individuals in Toronto, Canada

Nisha Andany 1 ; Sharon L.Walmsley 2 ; Allison McGeer 3 ; for theToronto Invasive Bacterial Diseases Network 1 Univ of Toronto, Toronto, ON, Canada; 2 Univ Hlth Network, Toronto, ON, Canada; 3 Mount Sinai Hosp, Toronto, ON, Canada

Background: Invasive pneumococcal disease (IPD) is an important cause of morbidity and mortality in HIV-infected persons. Those with HIV are at higher risk of IPD than the general population; however, incidence has declined with antiretroviral therapy. This study examined trends in incidence, serotype distribution and antibiotic susceptibility over time to assess the impact of prophylaxis and childhood immunization. Methods: Population-based surveillance for IPD has been ongoing in metropolitan Toronto and Peel region since 1995. Clinical information is collected by patient interview and chart review. One isolate per episode is serotyped and antimicrobial susceptibility testing is performed. Annual incidence from 1995 to 2011 was calculated using HIV population prevalence data. Results: HIV-infected persons accounted for 316/8446 (3.74%) of IPD episodes from 1995 to 2015. Median age was 41.7 years (IQR 35.7-48.9); 85.8% of episodes occurred in men. The most common site of infection was pneumonia (84.5%), followed by bacteremia without focus (8.9%). From available data, 102/232 (44.0%%) had received pneumococcal vaccine > 2 weeks prior to infection, and 52/239 (21.8%) were on trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis. Annual incidence of IPD decreased over time (Figure 1). Case-fatality peaked at 16.5% between 2000-2004, then decreased to 4.9% in 2005-2009 and 5.2% in 2009-2015. Vaccination status did not affect case-fatality (p=0.2). Over the study period, there was no change in the proportion of episodes due to PPV-23 serotypes (24.4%); there was a decrease in PCV7 serotypes (54.8% to 17.3%) and an increase in PCV13/not PCV7 (16.1% to 30.8%) and non-conjugate vaccine serotypes (6.5% to 28.9%). Serotype distribution since 2009 has remained stable with 51.9% attributable to non- conjugate vaccine serotypes, 30.8% to PCV-13 serotypes and 17.3% to PCV-7 serotypes. Resistance to erythromycin, penicillin and ceftriaxone increased over time, but remained low for amoxicillin and levofloxacin. TMP/SMX prophylaxis was associated with resistance to TMP/SMX (p<0.0001), but not penicillin (p=0.13). Conclusions: HIV-positive persons accounted for 3.7% of IPD over a 20-year period; incidence decreased over time, particularly after introduction of a publicly-funded PCV for children in 2005. Guidelines now recommend PCV13 for immunocompromised persons; ongoing surveillance will be important to assess the impact of this recommendation on incidence, serotype distribution and mortality for those with HIV.

Poster Abstracts

320

CROI 2016