CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

linear regression. We further estimated the weighted prevalence of individual OIs combining the data over six years, reporting estimates where the coefficient of variation was less than 30%. Data were weighted for unequal selection probabilities and non-response. Results: Overall, 7.0% (95% confidence interval [CI]: 6.1–8.0) of patients had at least one OI diagnosis documented in their medical record within the past 12 months. OI prevalence decreased from 8.0% (CI: 6.3–9.8) in 2009 to 6.0% (CI: 5.3–6.8) in 2014 (βtrend = -0.006; Ptrend = 0.03). Overall prevalence of individual OIs was as follows: wasting syndrome due to HIV, 1.4% (CI: 1.1–1.7); Pneumocystis pneumonia (PCP), 1.2% (CI: 0.9–1.6); candidiasis of bronchi, trachea, esophagus, or lungs, 1.1% (CI 0.9–1.3); herpes simplex (chronic ulcers greater than one month’s duration or bronchitis, pneumonitis, or esophagitis), 0.8% (CI: 0.4–1.2); and Kaposi’s sarcoma, 0.7% (CI: 0.6–0.8). Conclusion: The overall prevalence of OIs among adults in HIV care decreased over time in the United States by 0.6% per year on average from 2009 to 2014. Specific OIs with the highest observed prevalence were found to be wasting syndrome, Pneumocystis pneumonia, candidiasis, herpes simplex, and Kaposi’s sarcoma. 738 SIGNIFICANT HIGHER CMV-REACTIVATION IN PJP PATIENTS WITH ADJUNCTIVE CORTICOSTEROIDS Gundolf Schuettfort , Sarah Tomasini, H.-R. Brodt, Philipp De Leuw, Siri Goepel, Gerrit Kann, Annette E. Haberl, Eva Herrmann, Timo Wolf, Christoph Stephan Univ Hosp Frankfurt, Frankfurt, Germany Background: Although the incidence of Pneumocystis jiroveci pneumonia (PJP) has declined with the widespread use of PJP prophylaxis and ART, PJP still remains the most common AIDS-defining infection in people living with HIV (PLWHIV) in western countries. The adjunctive administration of corticosteroids in severely ill patients with PJP has been recommended since the 1990`s and results in a significant reduction in overall mortality. Current recommendations are based on studies from the pre-HAART era. In addition, there is growing evidence that in these severely ill patients the rate of CMV infection and reactivation has been considerably underestimated. Data on reactivation of CMV and resulting complications in PLWHIV with PJP receiving adjunctive corticosteroids are still lacking. In order to assess the impact of adjunctive corticosteroids on the incidence of CMV reactivation in PLWHIV with PJP we conducted a retrospective cohort study with patients from the HIV-Center Frankfurt. Methods: All patients from the Frankfurt HIV Cohort diagnosed with PJP between January 2005 and December 2013 were analyzed in this retrospective study. The primary endpoint was the incidence of CMV-reactivation in PJP-patients with vs. without adjunctive corticosteroids. CMV-reactivation was defined as presence of CMV-specific immunoglobulin G antibodies in combination with a positive CMV-PCR > 5000 copies/ml. Statistics were done with nonparametric tests using a significance level of alpha=5%. Results: A total of 160 HIV-positive patients (20.3% female) were included in the analysis, 76.6% ART- naïve and 23.4% treatment-experienced. All 160 patients received Trimethoprim-sulfamethoxazole as PJP treatment.111 patients (69.3%) received adjunctive corticosteroids. The baseline characteristics of the study population are shown in table 1. With respect to potential confounders the rate of CMV reactivation was significantly higher in patients receiving adjunctive corticosteroids (65.7% vs. 34.7%; p = 0.0005; ODDS- Ratio = 3.48 ; CI = 1.171– 7.084). Conclusion: Our data indicate an independent correlation between the administration of adjunctive corticosteroids and CMV-reactivation in HIV-positive PJP-patients. CMV- reactivation had no impact on mortality, most likely because 94% of these patients received specific CMV-treatment. Thus it is mandatory to be aware of a potential higher risk of CMV-reactivation and the resulting complications in HIV-positive patients receiving adjunctive corticosteroids for PJP treatment. 739 WITHDRAWN 740 PREVALENCE OF ADVANCED HIV DISEASE AND CRYPTOCOCCAL INFECTION IN GABORONE, BOTSWANA Kwana Lechiile 1 , Hannah K. Mitchell 1 , Fredah Mulenga 2 , Irene Goercke 3 , Martin S. Azama 2 , Mooketsi Molefi 3 , Tshepo B. Leeme 1 , Mark W. Tenforde 4 , Madisa Mine 5 , Joseph N. Jarvis 6 1 Botswana–UPenn Partnership, Gaborone, Botswana, 2 Ministry of Hlth, Gaborone, Botswana, 3 Univ of Botswana, Gaborone, Botswana, 4 Univ of Washington, Seatle, WA, USA, 5 Natl Hlth Lab, Gaborone, Botswana, 6 US CDC, Gaborone, Botswana Background: Botswana has one of the leading HIV-treatment programs in sub-Saharan Africa and is close to meeting the UNAIDS 90-90-90 targets. However, the incidence of opportunistic infections such as cryptococcal meningitis remains high. We performed a study to describe the CD4 count distribution of all patients receiving HIV care in the public sector in the greater Gaborone area, determine the prevalence of advanced disease (CD4<200 cells/µL), and to explore the utility of cryptococcal antigen (CrAg) screening. Methods: From January 2014 to January 2016, CD4 data were collected from all patients attending antiretroviral therapy (ART) clinics in greater Gaborone and the referral hospital. Residual EDTA blood specimens from patients with CD4 counts ≤100 cells/µl were routinely screened for CrAg from January 2015 using the IMMY CrAg® Lateral Flow Assay. Basic demographic data were collected. CrAg results were communicated to the responsible clinicians along with provision of a standardized treatment algorithm. Results: 140,793 CD4 counts were performed from 32,879 individuals; median age was 37 years and 65% (21,294) were female. The median CD4 count was 469 cells/µl (IQR 329-635); 24% (7,962/32,879) had nadir CD4 counts ≤200 cells/µl, and 11% (3,655/32,879) ≤100 cells/µl. Men were significantly more likely to have a nadir CD4 <200 cells/µl (OR 2.0, 95%CI 1.9-2.1). Two thousand samples from 1,622 individuals were screened for CrAg; 5.6% (91/1622) of individuals were CrAg positive. The median age of the 1,622 individuals screened was 37 years (IQR 32-44) and 49.6% (805) were female. CrAg positivity was associated with lower CD4 count (median CD4 32 cells/µl vs 56 cells/µl, p<0.001) and male sex (7.0% CrAg positive vs 4.2% p=0.016). 9.3% (151) of patients were hospitalized at the time of CrAg testing, and the remainder were outpatients. 4.4% (64/1471) of outpatients and 17.9% (27/151) of inpatients were CrAg positive. Conclusion: There are still a substantial number of individuals with advanced immune suppression in the ART program in Gaborone, and the prevalence of cryptococcal infection in this group is high. Cryptococcal antigen screening would be a worthwhile and feasible intervention in this setting. Almost one in five inpatients with CD4 <100 cells/µL had cryptococcal infection, and screening should be routine in this group. Further work is needed to better understand why individuals, often men, are still presenting with low CD counts despite widespread access to HIV testing and ART. 741 CRYPTOCOCCAL ANTIGEN SCREENING AMONG PATIENTS WITH ADVANCED HIV INFECTION IN VIETNAM Dat Q. Vu 1 , Kinh V. Nguyen 2 , Dung T. Nguyen 2 , Moses Bateganya 3 , Sheryl Lyss 3 , Anh T. Ho 4 , Jonathan Kaplan 3 , Presented by Hanzhu Qian, for the CRICSTeam 1 Hanoi Med Univ, Hanoi, Vietnam, 2 Natl Hosp for Trop Diseases, Hanoi, Vietnam, 3 CDC, Atlanta, GA, USA, 4 CDC, Hanoi, Vietnam Background: South and Southeast Asia have the second highest burden of cryptococcal meningitis (CM) among people living with HIV after sub-Saharan Africa. The World Health Organization (WHO) recommends that countries consider cryptococcal antigen (CrAg) screening and fluconazole treatment of asymptomatic patients with advanced HIV to prevent cryptococcal disease, based on CrAg prevalence. We present preliminary data on the baseline prevalence of CrAg and other opportunistic infections in Vietnam to informwider implementation of CrAg screening and other strategies to reduce mortality among patients with advanced HIV disease. Methods: At 22 HIV outpatient clinics in Vietnam, we implemented a reflex CrAg screening program using lateral flow assay for newly presenting, antiretroviral therapy (ART)- naive patients with CD4 count ≤100 cells/µL. Those testing CrAg-positive were treated with high-dose fluconazole according to WHO’s and national guidelines. We enrolled consenting patients for study follow-up, calculated CrAg prevalence, and summarized baseline prevalence of other opportunistic infections. Results: Between August 2015 and June 2016, 723 (40.5%) of 1,787 ART-naive patients across 22 participating OPCs had CD4 count ≤100 cells/µL. Among these patients, we enrolled 642 (89%). In the current interim analysis, we use data from 587 (91.4%) patients whose baseline data were fully documented in our database by the end of June 2016. 150 (25.6%) patients were female. Median age was 35 years (interquartile range (IQR), 31-41). Median CD4 count at enrollment was 25 (IQR, 11-56). Common opportunistic infections documented at baseline included tuberculosis (31%), oral candidiasis (15.5%)and Pneumocystis pneumonia (5.3%). Among 17 (2.9%) CrAg-positive patients, 16 had no meningitis symptoms and were treated with high-dose fluconazole. One patient was diagnosed with CM and was treated according to the national guidelines.

Poster and Themed Discussion Abstracts

CROI 2017 322