CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Among 3,044 clients, 292 (9.6%) had HIV seroconversion only, 317 (10.4%) had syphilis seroconversion only, and 78 (2.6%) had dual HIV and syphilis seroconversion. Among those with dual seroconversion, the median time to HIV infection was 2.1 years (25-75 Interquartile Range [IQR] 1.3-3.5) and the median time to syphilis infection was 2.8 years (25-75 IQR 1.4-4.0) (p=0.354). Conclusion: Over 10 years, prevalent HIV and syphilis coinfection was common and increased each year; 2.6% of clients had dual HIV and syphilis seroconversion. Continued surveillance for HIV and syphilis infection among MSMwill support prevention efforts. 863 SUBSEQUENT AND RECURRENT STI AMONG THAI MSM AND TG IN TEST AND TREAT COHORT Akarin Hiransuthikul 1 , Supanit Pattanachaiwit 1 , Nipat Teeratakulpisarn 1 , Parinya Chamnan 2 , Panita Pathipvanich 3 , Suchart Thongpaen 4 , Supabhorn Pengnonyang 1 , Deondara Trachunthong 1 , Nittaya Phanuphak 1 , for theThai MSM/TGTest andTreat Study Group 1 The Thai Red Cross AIDS Rsr Cntr, Bangkok, Thailand, 2 Sanpasitthiprasong Hosp, Ubonratchathani, Thailand, 3 Lampang Hosp, Lampang, Thailand, 4 Mahasarakham Hosp, Mahasarakham, Thailand Background: Men who have sex with men (MSM) and transgender women (TG) are at increased risk for sexually transmitted infections (STI). However, the information on the incidence and characteristic of those who have subsequent and recurrent STI are lacking. Methods: During December 2012 - December 2013, Thai MSM and TG aged ≥18 years were enrolled into the Test and Treat study. Participants who came to follow-up visit were analyzed for subsequent STI; and recurrent STI was analyzed from those who had ≥1 STI at baseline. Blood collected for syphilis and pharyngeal swab, urine, anal swab, and neovaginal swab (for TG) for gonorrhea and chlamydia screening at baseline, month 12, and month 24 were used to identify subsequent and recurrent STI (defined as any subsequent STI diagnosed over a 24-month period). Cox proportional hazards regression was used to identify potential predictors of recurrent STI among baseline covariates. Results: From 811 MSM and TG enrolled, 448 (55.2% of total) came to follow-up visit and had STI test. Subsequent STI incidence was 2.2 per 100 person-months. Common subsequent STIs were anal chlamydia (1.1 per 100 person-months), pharyngeal and anal gonorrhea, and syphilis (0.6 per 100 person-months each). Baseline HIV-positive status increased risk of subsequent STI (adjusted hazard ratio [aHR] 1.8; 95% CI 1.2-2.8, p=0.006). Other independent risk factors were low income, baseline anal chlamydia, syphilis, had/ unsure of previous STI, and popper use (p<0.05). Of 448 participants, 154 (34.4%) had baseline STI, 50 (32.5% of 154) were HIV-positive and 96 (62.3% of 154) had recurrent STI within a 24-month period. The incidence for recurrent STI was 3.8 per 100 person-months. Those with baseline anal chlamydia, pharyngeal chlamydia, and anal gonorrhea had the highest incidence rate of recurrent infection with the same respective diseases (2.6, 2.2, and 1.6 per 100 person-months, respectively). Baseline HIV-positive status (aHR 1.8; 95% CI 1.14-2.85, p=0.012) and circumcision (aHR 2.2; 95% CI 1.12-4.32, p=0.021) were associated with increased risk for recurrent STI. Conclusion: Among Thai MSM and TG enrolled into the Test and Treat study, baseline HIV-positive status increased the risk of both newly acquired and re-acquired STI over a 24-month period. Targeted STI educational campaigns and increased frequency of STI screening for earlier diagnosis and treatment are needed to improve STI outcome among MSM and TG in both HIV prevention and treatment programs. 864 RISK FACTORS AND INCIDENCE OF SYPHILIS IN HIV-INFECTED PERSONS, THE HOPS, 1999–2015 Richard Novak 1 , Abdelhamid Ghanem 1 , Rachel Hart 2 , Douglas Ward 3 , Carl Armon 3 , Kate Buchacz 4 1 Univ of Illinois at Chicago, Chicago, IL, USA, 2 Cerner Corp, Kansas City, MO, USA, 3 Dupont Circle Physicians Group, Washington, DC, USA, 4 CDC, Atlanta, GA, USA Background: The incidence of syphilis has been increasing, especially among gay, bisexual and other men who have sex with men (MSM) for at least a decade in the United States (US). We assessed incidence, temporal trends and associated risk factors for newly diagnosed syphilis infections among HIV-infected patients in care during a 15-year period. Methods: We analyzed data from the HIV Outpatient Study (HOPS) cohort participants seen at ten US HIV clinical practice sites from January 1, 1999 to June 30, 2015. New syphilis cases were defined based on a combination of established laboratory parameters as well as clinical diagnoses. We assessed incidence rates of syphilis by patient sociodemographic, clinical and behavioral characteristics, and performed multivariable Cox proportional hazards regression analyses of risk factors for new syphilis infections. Results: We studied 6888 HIV-infected participants, among whom 641 had one or more new syphilis diagnoses during a median follow-up of 5.2 years (interquartile range: 2.0 to 10.8). Most study participants were male (78%) and aged 31-50 years (Table) and 56% of participants were MSM, 28% heterosexuals, 10% persons who inject drugs (PWID) and 6% other/unknown risk. There were a total of 799 syphilis diagnoses for an overall incidence of 1.8 per 100 person-years (95% Confidence Interval [CI] 1.6-1.9). The crude incidence rate was higher among MSM than heterosexuals (2.6 vs. 0.7, P <0.001), was higher among participants aged 18-30 years than over 50 years (3.0 vs. 0.8, P<0.001), and was elevated among non-Hispanic blacks vs. white and Hispanic/Latino participants (Table). Rates of diagnosed syphilis were highest in the most recent time period, 2011-2015, as compared with prior periods (Table). In multivariable analyses, the independent risk factors for syphilis included (all P< 0.001): being aged 18-30 years (hazard ratio [HR] 1.8, CI 1.5-2.1) vs older, having MSM HIV risk (HR 4.4, CI 3.6-5.5) vs other HIV risks, being black, non-Hispanic (HR 1.8, CI 1.5-2.1) vs other race/ethnicities, and being observed during 2011-2015 (HR 2.3, CI 1.7-3.0) vs earlier periods. Conclusion: The steady increases in the syphilis incidence rate through 2015, particularly among HIV-infected patients who are younger, black, non-Hispanic and MSM, reflect ongoing sexual risk. Results highlight need for enhanced and targeted prevention interventions in this population. 865 INCIDENT SYPHILIS INFECTIONS DECLINED IN WELL-CHARACTERIZED COHORT OF HIV+ PERSONS Anuradha Ganesan 1 , Xun Wang 2 , Robert Deiss 3 , Julie Pavlin 3 , Tomas Ferguson 4 , Thomas O’Bryan 5 , Jason Okulicz 6 , Ryan Maves 7 , Karl Kronmann 8 , Grace Macalino 3 1 Uniformed Services Univ of the Hlth Scis, Rockville, MD, USA, 2 Henry M. Jackson Fndn for the Advancement of Military Med, Rockville, MD, USA, 3 Tripler Army Med Cntr, Honolulu, HI, USA 4 Uniformed Services Univ of the Hlth Scis, San Antonio, TX, USA, 5 San Antonio Military Med Cntr, San Antonio, TX, USA, 6 Naval Med Cntr San Diego, San Diego, CA, USA, 7 Naval Med Cntr Portsmouth, Portsmouth, VA, USA Background: Since 2000, syphilis rates have increased in the US; racial minorities are disproportionately represented. We used results of serially collected Non-Treponemal tests (NTrt) to examine incident syphilis infections in the US Military HIV Natural History Study (NHS), a cohort of HIV-infected Department of Defense beneficiaries Methods: We included all NHS subjects with visits since 2004.Syphilis was diagnosed with a positive NTrt confirmed by treponemal testing. Descriptive statistics included temporal trends between 2004 and 2015 and sexual risk behavior data from a computer-assisted self-interview (administered since 2014). Time-updated Poisson regression was used to examine incidence rate ratios, while logistic regression was used to examine sexual risk behavior correlates. Results: 2719 participants contributed 14,504 person years (PY) of follow-up. Since 2004, 423 incident infections (99.3%male, 57.2% African- American, 27%- Caucasian) were recorded in the NHS database. Syphilis incidence was highest during calendar years 2004-2007 [3.2/100 PY (2.7, 3.7)], and lowest between 2012-2015 [2.4/100 PY (2.0, 2.9); p=0.03]. Rates in 2008-2011 were similar to those observed in 2004-2007 [3.1/100 PY (2.6, 3.6); p=0.74]. While overall rates were highest among African-American [3.9/100 PY (3.4, 4.4)], they declined only in this ethnic group over time (Table). Of 1,328 individuals completing the questionnaire, 53 men were subsequently diagnosed with syphilis. Compared to those without syphilis, subjects with syphilis often perceived themselves as being at medium or high risk for infection (45% vs.17%, p=<.0001). In a univariate model, ethnicity, drug use, higher numbers of male sex partners, participating in oral or anal intercourse, and use of social media to seek partners were associated with syphilis. In a selected multivariate model AA ethnicity [compared to Caucasian, OR 2.4 (1.2-4.8)] and participation in anal intercourse [OR 3.0 (1.5-6.2) remained independently associated with infection Conclusion: Syphilis rates in the NHS have declined, especially among AA, though this group remains disproportionately affected. Nonetheless, in spite of high self-perception of risk, subjects with syphilis still had high prevalence of high risk sexual behaviors. Given the observed association with social media use and subsequent infection, using social media to target high risk groups for prevention messages is a strategy worth pursuing in this setting.

Poster and Themed Discussion Abstracts

CROI 2017 373