CROI 2016 Abstract eBook

Abstract Listing

Oral Abstracts

162 Is Intensive Cervical Cancer Screening Justified in ImmunosuppressedWomen?

Michael J. Silverberg 1 ;Wendy Leyden 1 ; Steven Gregorich 2 ; Karen K. Smith-McCune 2 ; Megan Huchko 2 ; Miriam Kuppermann 2 ; Shalini Kulasingam 3 ; George F. Sawaya 2 1 Kaiser Permanente Northern California, Oakland, CA, USA; 2 Univ of California San Francisco, San Francisco, CA, USA; 3 Sch of PH, Univ of Minnesota, Minneapolis, MN, USA Background: Current cervical cancer screening guidelines recommend more intensive screening of immunosuppressed women, including HIV+ women and those on immunosuppressive agents (e.g., calcineurin inhibitors, corticosteroids). Whether this approach is justified in settings with uniform access to comprehensive care, including combination antiretroviral therapy and cervical cancer screening, is unclear. Methods: Among adult members of a large integrated healthcare system, we performed a nested case-control study of 20,157 incident cases of cervical intraepithelial neoplasia (CIN) 2, 3 or cancer (CIN 2+) and 5:1 selected controls (N=100,780), matched on age, diagnosis date (+/-1 year), years in the health plan (+/-1 year), and date of first health plan Pap test (+/-1 year). A primary predictor was HIV status, both overall comparing HIV+ and HIV- women, and among HIV+ women stratified by recent CD4 T-cells/µL (<200, 200-499, ≥500 cells/µL). A second predictor of interest was recent (<18 months) prescription of immunosuppressive agents. Odds ratios (OR) from conditional logistic regression models were adjusted for race/ethnicity, smoking (ever/never), and recent hormonal prescriptions (e.g., oral contraceptives, hormone replacement therapy). Results: The mean age of CIN 2+ cases and controls was 36 years. 52% of cases were white, 19%were Hispanic, and 8%were black; race/ethnicity was similar in controls. Cases were more likely than controls to be current smokers (20% vs. 13%) and to have been prescribed hormones (49% vs. 44%). The prevalence of HIV was 0.18% in cases and 0.08% in controls, with 47% of HIV+ women having CD4 counts ≥500 cells/µL. As shown in the Table, the adjusted OR for CIN 2+ for HIV+ women compared with HIV- women was 2.2 (95% CI: 1.5-3.3). In the model stratifying HIV+ women by CD4 count, adjusted ORs (HIV- reference) were 0.9 (0.4-1.9), 3.5 (1.9-6.5), and 5.3 (1.8-15.2), for women with CD4≥500, 200-499, and <200 cells/µL, respectively. The prevalence of immunosuppressive agents was 6.8% in CIN 2+ cases and 6.4% in controls, with an adjusted OR of 1.05 (0.99-1.12). Results were similar for the outcome of CIN 3+ (data not shown). Conclusions: The increased risk of CIN 2+ among HIV+ women appears to be limited to those with CD4 counts <500 cells/µL. Immunosuppressive agents do not appear to confer significant increased risk of CIN 2+. More intensive screening of HIV+ women may be justified based on CD4 cell counts, but not for women prescribed immunosuppressive agents.

Oral Abstracts

163

WITHDRAWN

164 Isolated Seminal HIV-1 RNA Shedding in African MenWith UninfectedWomen Partners AndrewMujugira 1 ; Connie M. Celum 1 ; Allan Ronald 2 ; Nelly R. Mugo 3 ; RobertW. Coombs 1 ; Jared M. Baeten 1 ; for the Partners PrEP StudyTeam 1 Univ of Washington, Seattle, WA, USA; 2 Univ of Manitoba, Winnipeg, MB, Canada; 3 Kenya Med Rsr Inst, Thika, Kenya

Background: Eliminating HIV-1 transmission using antiretroviral therapy (ART) requires suppressing HIV-1 RNA in plasma and genital secretions. However, intermittent seminal shedding occurs despite effective ART and suppressed plasma HIV-1 RNA concentrations. Given the need to counsel HIV-1 infected men initiating ART about their transmission risk, information about timing and likelihood of achieving HIV-1 RNA suppression in semen and male-to-female HIV-1 transmission is needed. Methods: We used data from a prospective study of heterosexual HIV-1 serodiscordant African couples (Partners PrEP Study) to assess the frequency and magnitude of seminal HIV-1 RNA shedding after 0-3, 4-6 and >6 months of ART. HIV-1 RNA was quantified in semen and blood plasma using the Abbott m2000 Real-Time HIV-1 assay (Abbott

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