CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

942

FERTILITY DESIRES OF HIV-POSITIVE MEN AND WOMEN IN THE US Susan E. Cohn 1 , Lisa B. Haddad 2 , Christina S. Hayford 1 , Anandi N. Sheth 2 , Justin A. Schmandt 1 , Joan S. Chmiel 1 1 Northwestern Univ, Chicago, IL, USA, 2 Emory Univ, Atlanta, GA, USA

Poster and Themed Discussion Abstracts

Background: A nationally representative US sample of HIV-infected women and heterosexual men in 1998 reported that 28-29% desired children in the future. Data on whether men who have sex with men want children in the future are limited. We examined the fertility desires among HIV-infected men and women initiating one of three modern antiretroviral therapy (ART) regimens. Methods: We included 1660 (all men and women aged ≤45 years who completed necessary questionnaires) of the 1809 participants in A5257. Self-reported questionnaire data were analyzed from baseline to 96 weeks after initiating ART. We defined MSM as men who have ever had sex with a man; MSW as men who have never had sex with a man; and W as all women enrolled. Primary outcome was desire to have children in the future (yes/maybe versus no) as reported at baseline and at 96 weeks. Multivariable logistic regression models were used to evaluate associations between sociodemographic variables at baseline and fertility desire at 96 weeks after ART initiation. Results: Participants’ characteristics were: 36%white, 40% black, and 22% Hispanic; median age was 36 years; 69%were MSM, 13%MSW, 18%W. At baseline, 42% desired children in the future (42%MSM, 38%MSW and 45%W) and 41% desired children at 96 weeks (41%MSM, 37%MSW, and 43%W). Fertility desire changed from baseline to 96 weeks in 20% of participants, with 9.5% of those not desiring children changing to desiring children, while 10.5% changed to no longer desiring children. Among women who desired children, 13.1% had had a tubal ligation or hysterectomy at baseline, whereas among MSM and MSWwho desired children, only 1% had had vasectomies. Multivariable analyses found that being black, having >high school degree, being <30 years old, and having no children were positively associated with desiring children in the future. Within the 3 subgroups, these same factors generally predicted wanting future children, with the exception of being black among W and MSW, of whomwell over half were black. Conclusion: During modern ART, about 40% of HIV-infected W and MSW desire more children before and 2 years after ART initiation. A similar proportion of MSM also desire future children. These results highlight the need for 1) regular assessment of family planning goals in HIV care settings; 2) access to comprehensive reproductive health, fertility, and contraceptive services, and; 3) prevention of vertical and heterosexual HIV transmission. 943 CHANGES IN GENITAL-TRACT HIV TARGET CELLS WITH THREE PROGESTIN-BASED CONTRACEPTIVES Lisa B. Haddad 1 , Alison S. Kohlmeier 2 , Richard Haaland 2 , Nakita Brown 1 , David Lupo 2 , Christina Mehta 1 , Anandi N. Sheth 1 , Kehmia Titanji 1 , Clyde Hart 2 , Igho Ofotokun 1 1 Emory Univ, Atlanta, GA, USA, 2 CDC, Atlanta, GA, USA Background: Recent findings suggest that the injectable contraceptive Depot Medroxyprogesterone acetate (DMPA) may increase the risk of HIV acquisition for women but the risk for other progestin-based contraceptives is not known. We evaluated the effect of DMPA, Etonogestrel Implant (Implant) and Levonorgestrel Intrauterine Device (IUD) use on HIV target cells in the genital mucosa of adult premenopausal HIV-negative women. Methods: Paired cervicovaginal lavage (CVL) and blood samples were prospectively obtained from eligible subjects pre (weeks 0, 2), and post (weeks 14, 16) contraceptive initiation, with contraception initiated at week 2. Genital tract leukocytes enriched from CVL and peripheral blood mononuclear cells (PBMC) were examined for T-cell markers (CD3, CD4) and HIV susceptibility, activation and trafficking markers (CCR7, CCR5, CD38, HLA-DR) by multicolor flow cytometry. Repeated-measures analyses using linear mixed models were used to estimate and compare study endpoints. Results: Participants in this analysis included 10 DMPA, 11 Implant, and 9 IUD users of African American (76.7%) and non-Hispanic white (20.7%) races with a mean age of 35.6 +/- 8.1 years. The percentage of genital tract CCR5+ CD4+ T cells increased after implant initiation (E=16.9, p=0.007) and with DMPA use (E=14.8, p =0.039) but only when samples with <100 CD3+ lymphocytes were excluded from the DMPA analysis. Genital tract CCR7+ CCR5+ CD4+ T-cell percentages increased with Implant use (E=10.9, p=0.005) but not with DMPA or IUD; CD38+ and HLA-DR+ CD4+ T-cell percentages did not change with these 3 contraceptives. PBMCs had increased CCR5+ CD4+ T-cell percentages with DMPA use (E=2.2, p=0.004) and increased CCR7+CCR5+ CD4+ T-cell percentages with implant use (E=10.9, p=0.005). Conclusion: DMPA and Etonogestrel Implant but not Levonorgestrel IUD use was associated with increased HIV target cell percentages in female genital tract lymphocytes. Implant use was associated with increased percentages of CCR5+ HIV target cells in the genital tract and blood capable of trafficking (CCR7+) to lymphoid organs. How these changes in genital tract HIV targets among progestin-based contraceptive users may affect their risk of HIV acquisition deserves further investigation. 944 DEPOT MEDROXYPROGESTERONE ACETATE INCREASES HIV-1 REPLICATION IN MUCOSAL TISSUE Charlene S. Dezzutti 1 , Seo Young Park 1 , Ingrid Macio 2 , Kenneth Marks 3 , Sidney Lawlor 3 , Catherine Chappell 4 , Katherine Bunge 4 1 Univ of Pittsburgh, Pittsburgh, PA, USA, 2 Univ of Pittsburgh Med Cntr, Pittsburgh, PA, USA, 3 Magee-Womens Rsr Inst, Pittsburgh, PA, USA, 4 Magee-Womens Hosp of UPMC, Pittsburgh, PA, USA Background: Women recruited into clinical trials evaluating HIV prevention products use effective forms of contraception or do not have sex with men. Exogenous progestins, such as hormonal contraceptives, could affect the capacity of mucosal tissue to replicate HIV-1. This study aimed to determine the effect of contraception on genital HIV replication using the ex vivo challenge assay, which collects cervical (CVX) and vaginal (VAG) tissue and exposes it to HIV-1. We hypothesize that tissue collected fromwomen using depot medroxyprogesterone acetate (DMPA) will replicate HIV-1 to significantly higher levels than other contraceptive methods. Methods: Healthy women (18-45 years old) using no hormonal contraception (no HC) (N=54), DMPA (N=30), levonorgestrel-intrauterine device (LNG-IUD) (N=37), or copper-IUD (Cu-IUD) (N=30) were enrolled. Two CVX and two VAG biopsies from each woman were collected using Tischler forceps and immediately treated with HIV-1BaL. After washing, the tissues were placed in culture with fresh medium. On days 3, 7, and 11, supernatants were collected for HIV-1 p24 quantification by ELISA. ANOVA F-tests with a Tukey post-hoc test were used to compare groups. The intraclass correlation coefficients (ICC) for CUM p24 for CVX and VAG tissues were calculated to evaluate intra-person variability.

CROI 2017 409