CROI 2016 Abstract eBook

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Oral Abstracts

Diagnostics). The primary outcome was seminal HIV-1 RNA concentration >80 copies/mL. Secondary biologic outcomes were pregnancy incidence, as an indicator of unprotected sex, and HIV-1 acquisition in initially uninfected women whose male partners initiated ART during follow-up. Results: We followed 1772 HIV-1 infected men for 4554 person-years. Of these, 755 initiated ART during follow up, and semen HIV-1 RNA results were available for 231 (31%). Median time from ART initiation to semen HIV-1 RNA quantitation was 2.96 months. Seminal HIV-1 RNA was detected in 20% (31/155), 10% (5/49) and 9% (6/70) of samples after 0-3, 4-6 and >6 months of ART, respectively. Among men with suppressed plasma HIV-1 RNA concentrations (<80 copies/ml) [N=192], the frequency of semen HIV-1 RNA detection was 7% (6/88), 3% (1/40) and 3% (2/64) in samples collected 0-3, 4-6 and >6 months after ART initiation. The median quantity of seminal HIV-1 RNA among those with suppressed plasma HIV-1 RNA was 2.97 log 10 copies/ml (range, 2.53-3.41). Plasma and semen HIV-1 RNA concentrations were correlated (Spearman’s r=0.58, p<0.001). After >6 months ART, pregnancy incidence was 13.7 per 100 person-years (9 pregnancies/66 person-years) after excluding time when pregnant or using contraception, and there were no male-to-female HIV-1 transmission events in the 231 ART-exposed couples. Conclusions: Seminal HIV-1 RNA shedding was rare and low quantity among heterosexual HIV-1 infected men who achieved plasma HIV-1 RNA suppression. No HIV-1 infections were observed among HIV-1 uninfected women partners, despite high pregnancy incidence, indicating no HIV-1 transmission in the context of unprotected sex. 165 Exploring the Effectiveness of Traditional Circumcision Practices in Preventing HIV Michael Pickles 1 ; Anne Cori 1 ; Sian Floyd 2 ; Helen Ayles 2 ; Nulda Beyers 3 ; Peter Bock 4 ; Sarah J. Fidler 1 ; Richard Hayes 2 ; Christophe Fraser 1 ; for the HPTN 071 (PopART) StudyTeam 1 Imperial Coll London, London, UK; 2 London Sch of Hygiene & Trop Med, London, UK; 3 Univ of Stellenbosch, Tygerberg, South Africa; 4 Univ of Stellenbosch, Cape Town, South Africa Background: Traditional male circumcision (TMC) is widespread across different cultures and religions, and is highly prevalent in sub-Saharan Africa. Given variability between cultures in the traditional procedure in terms of foreskin removal, it is unknown if TMC is always as protective against HIV as voluntary male medical circumcision (VMMC) regardless of the traditional procedure used. Methods: HPTN 071 (PopART) is a large-scale combination prevention trial underway in South Africa and Zambia, for which a population cohort of adults aged 18-44 has been randomly recruited. We use logistic regression on data from the baseline survey of the population cohort to examine associations between measured HIV serostatus and self-reported circumcision status, adjusting for potential covariates. We divide individuals into those who have not been circumcised, and those who have undergone one of the following: TMC in Zambia; TMC in South Africa; VMMC; and those who report being circumcised by a practitioner other than a traditional practitioner or government health worker, or report being circumcised but do not specify by who. We differentiate TMC by country to reflect that the traditional procedure used may differ. Results: 5,301 out of the 11,231 men in the population cohort reported being circumcised. 60.6% of those circumcised reported being circumcised by a traditional practitioner, and 28.5% reported VMMC. 83.2% of circumcised men in South Africa (mostly Xhosa) were circumcised by a traditional practitioner, while only 14.0% of circumcised men in Zambia had undergone TMC. Figure 1 shows that in both countries HIV prevalence was higher amongst men who have undergone TMC (16.1% in South Africa; 16.7% in Zambia) than those who had undergone VMMC (6.3% and 7.8% respectively). After adjusting for age, education, marital status and number of lifetime partners, HIV prevalence remained significantly higher in men who underwent TMC in both South Africa (adjusted odds ratio=1.67, 95% confidence interval 1.32-2.14, P<0.001) and in Zambia (1.55, 95% confidence interval 1.00-2.36, P=0.046) compared to those who underwent VMMC. Conclusions: Traditional male circumcision, as practiced by ethnic groups in South Africa and Zambia, is associated with higher HIV prevalence than voluntary male medical circumcision. Further work, designed to examine the extent to which traditional circumcision, as practiced in this and other regions, is protective against HIV acquisition, should be carried out.

Oral Abstracts

166 2013-14 Rwanda HIV Incidence Household Survey: Understanding HIV Epidemic in Rwanda Eric Remera 1 ; Jean Paul Uwizihiwe 1 ; Steve Kanters 2 ; Augustin Mulindabigwi 1 ; Mwumvaneza Mutagoma 1 ; Edward Mills 2 ; Sabin nsanzimana 3

1 Inst of HIV/AIDS Disease Prevention and Control, Rwanda Biomed Cntr, Kigali, Rwanda; 2 Global Evaluative Scis, Vancouver, BC, Canada; 3 Rwanda Biomed Cntr, Kigali, Rwanda Background: In Rwanda since the scaling up of the antiretroviral therapy ten years ago, the HIV prevalence among adults aged 15 to 49 years has been stable at 3%. Although, the incidence is a more informative epidemiological measure of the HIV epidemic, until now Rwanda has relied on models and estimates of this measure. We conducted the first nationally representative HIV incidence household survey in Rwanda among adults aged 15 to 49 to better characterize its HIV epidemic. Methods: A prospective HIV incidence population-based survey conducted in all five Rwandan provinces for the year period of 2013-2014 and using two-stage sampling. We randomly selected 492 villages in the first stage and 14 households in the second stage. We obtained a sample of 13,728 respondents from 6,796 households. Participants were surveyed on their HIV knowledge, risky behaviour and demographics, and they were HIV tested using rapid tests and ELISA. Those testing HIV negative were enrolled in the cohort and those testing HIV positive were only included in the baseline survey. The cohort was followed for a year, with no special intervention or education. After a year, the 12,686 (92%) participants who completed follow-up were HIV re-tested and re-surveyed.

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CROI 2016