CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: Lifetime self-reported obstetric history was collected from 269 HIV+ and 215 HIV- women enrolled in the CARMA cohort from December 2008 to March 2016. Total number of pregnancies, live births, spontaneous and therapeutic abortions, and ectopic pregnancies were compared between the groups. Total pregnancy and live birth rates were then analyzed using negative binomial regressions for count data to calculate unadjusted and adjusted (for age, ethnicity, education, and substance use history) incident rate ratios (IRR). Results: HIV+ women were younger, (38.3y vs. 42.2y p=0.007), more likely to be of Black ethnicity (19.7% vs. 3.3% p<0.0001), without a high school diploma (31.2% vs. 24.7%, p<0.0001) and with a history of substance use (37.9% vs. 32.6% p=0.005) compared with HIV- peers. HIV+ women had a greater number of pregnancies [median (IQR) 3 (1-4) vs. 2 (0-3) p<0.0001] and live births [2 (1-3) vs. 1 (0-2) p=0.003] as compared with controls. HIV+ and HIV- rates of spontaneous abortion (16.4% vs. 18.2% p=0.65) and ectopic pregnancy (1.3% vs. 0.6% p=0.10) were similar, while proportion of pregnancies ending with therapeutic abortion trended toward being higher (22% vs. 17% p=0.06). Given the differences between the groups, particularly as age is a major predictor of fertility, a model adjusted for the significant factors above was used to compare number of live births, and pregnancies between the groups. In the adjusted model the HIV+ group still had a higher rate of pregnancies (IRR=1.63 p<0.0001) and live births (IRR=1.54 p<0.0001) compared to HIV- controls. Conclusion: Our data demonstrate pregnancy and live birth rates among HIV+ women in the CARMA cohort are 1.5 and 1.6 times greater than HIV- controls respectively. This suggests that in the post cART era, HIV+ women experience similar reproductive potential to their HIV- peers. 940 EARLY ONSET MENOPAUSE AMONG WOMEN LIVING WITH HIV IN CANADA Nisha Andany 1 , Angela Kaida 2 , Alexandra de Pokomandy 3 , Lu Wang 4 , V. Logan Kennedy 1 , Mark Yudin 5 , Kath Webster 6 , Anita Benoit 7 , Mona Loutfy 1 , for the CHIWOS ResearchTeam 1 Women’s Coll Rsr Inst, Toronto, Ontario, Canada, 2 Simon Fraser Univ, Burnaby, British Columbia, Canada, 3 McGill Univ, Montreal, Canada, 4 BC Cntr for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, 5 St. Michael’s Hosp, Toronto, Ontario, Canada, 6 CHIWOS Study, Vancouver, Canada, 7 Univ of Toronto, Toronto, Ontario, Canada Background: The interplay between HIV and aging has become crucial. Menopause is a pivotal age-related transition for women. Women with HIV are most likely to experience early menopause (EM) (menopause between 40-45years) and premature ovarian failure (POF) (menopause <40 years). We measured the prevalence and correlates of EM and POF in a cohort of post-menopausal Canadian women with HIV. Methods: We used baseline survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), a prospective community-based study of 1425 women with HIV aged >=16 years in British Columbia, Ontario and Quebec enrolled from October 2013 to June 2015. Analyses were restricted to post-menopausal women and excluded women who had never had menses, were pregnant, or using hormonal contraception. Multivariable logistic regression models assessed independent correlates of EM and POF combined (i.e. menopause <45 years). Results: 232 women were included. Median age was 55 (IQR=51,59) and years since HIV diagnosis was 15 (IQR=10,20); 53% of women were White, 22% African/Caribbean/ Black and 19% Indigenous; 39% had history of injection drug use (IDU), 95%were on ART and 87% had viral loads <50 copies/mL. Median age of menopause was 48 years (IQR=43,51); 29.3% of women had menopause <45 years: 16.4%with EM and 12.9%with POF. In univariate analyses, menopause <45 years was associated with (trend) longer duration of HIV (p=0.05), recreational drug use (p=0.02), IDU (p=0.005), and hepatitis C (p=0.006). Older age at interview (P<0.001), being born outside of (p=0.041) and having high-school education or higher (p=0.009) reduced risk of EM/POF. The multivariable model demonstrated a trend for increased risk of EM/POF with longer duration of HIV (aOR 1.04,95%CI=0.0.99-1.09). EM/POF was less likely with older age at interview (aOR 0.86,95%CI=0.81-0.92); having high-school education or higher (aOR 0.48,95%CI=0.22-1.01) was borderline significant. IDU was not independently associated with EM/POF in the multivariate model (aOR 1.43,95%CI=0.73-2.77). Conclusion: In this cohort of post-menopausal women with HIV, median age of menopause was 48 years; 3 years lower than the general population; 29% of women had menopause <45 years, and 13% had POF, substantially higher than the 1% rate of POF in Canada. Menopause <45 years was associated in univariate analyses with age, duration of HIV, region of birth, education, drug use and hepatitis C, but only age at interview remained significant in multivariate analyses. 941 COST-EFFECTIVENESS OF 2 METHODS TO TREAT CERVICAL DYSPLASIA IN HIV-POSITIVE WOMEN Naomi Lince-Deroche 1 , Craig Van Rensburg 1 , Jane Phiri 1 , Pamela Michelow 2 , Jennifer Smith 3 , Cindy Firnhaber 4 1 Hlth Economics and Epi Rsr Office, Johannesburg, South Africa, 2 NHLS, Johannesburg, South Africa, 3 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 Right to Care, Johannesburg, South Africa Background: HIV-positive women are at high risk of acquiring human papillomavirus and developing cervical cancer. Fortunately cervical cancer is preventable when early screening and treatment are available. We aimed to estimate the costs and cost-effectiveness of cryotherapy and large loop excision of the transformation zone (LLETZ) for treating cervical intraepithelial neoplasia or greater (CIN2+) in HIV-infected women taking antiretroviral treatment (ART) in Johannesburg, South Africa. Methods: Effectiveness data were derived from a clinical trial completed at a large, public, outpatient ART clinic. HIV-positive women with CIN2+ and eligible for cryotherapy (i.e. whole lesion visible, squamocolumnar junction visible, and lesion on less than 75% of the ectocervix) were randomly assigned to cryotherapy or LLETZ. Six months post-treatment, women had a Pap smear and colposcopic biopsy (CB); if CIN2+ was present, LLETZ was performed regardless of initial assignment. At 12 months, Pap and CB were repeated; having no evidence of CIN2+ was considered successful treatment. Micro-costing was conducted from the provider perspective. We included personnel, supplies, equipment and laboratory costs. Service volume assumed full productivity for an eight-hour work day. Capital costs were annualized using a discount rate of 3% and depreciation periods recommended by the South African Revenue Service. Costs reflect USD 2015. Results: During the study, 166 women were randomized to treatment: 86 LLETZ, 80 cryotherapy. LLETZ was performed by medical officers, cryotherapy by primary health care nurses. Table 1 provides the total average cost per procedure alone, total costs per group, and the cost per case cured for each treatment group. Total costs and cost per case cured include diagnostics and follow-up LLETZ treatment if needed. LLETZ was more costly – both in total average costs and the cost per case cured, mostly due to high laboratory costs (87.6% of the total costs). Bivariate sensitivity analysis did not alter the comparative cost findings. Conclusion: South African guidelines indicate that LLETZ should be offered freely in the public sector. In practice access is limited. In this analysis, cryotherapy followed by LLETZ at 6 months, if necessary, was more cost-effective in treating CIN2+ in eligible HIV-positive women. Despite higher costs, access to LLETZ remains important as not all women are eligible for cryotherapy, and LLETZ may be required for follow-up treatment.

Poster and Themed Discussion Abstracts

CROI 2017 408