CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Results: HPV testing followed by treatment (test-and-treat) at 2-year intervals was the most effective strategy that was also cost-effective, reducing lifetime cancer risk by 56.6%with an ICER of US$3,010 per year of life saved (YLS) (Table). Other cost-effective strategies included Pap testing (referral threshold: HSIL+) at 1-, 2-, and 3-year intervals, and HPV test-and-treat at 3-year intervals. Pap (referral threshold: ASCUS+), HPV testing with 16/18 genotyping, and HPV testing with Pap or visual triage of HPV-positive women were less effective and more costly than alternatives (i.e., dominated). HPV test-and-treat was consistently the most effective strategy that was also cost-effective as costs, test performance, visit compliance, cryotherapy eligibility, and treatment effectiveness were varied. The ICER for HPV test-and-treat at 2-year intervals fell to $1,500/YLS when the cost of HPV testing was reduced to $20/test. Conclusion: Screening HIV-infected women with an HPV test-and-treat approach is cost-effective in South Africa. If resources are available, this population may benefit from screening more frequently than every 3 years. Price reductions in HPV tests would further improve cost-effectiveness.

serotype can be seen in Figure 1(A). Clearance of HPV infection was seen only in 14 cases in type16, but not for type 18. There were 18 persistent high-risk HPV infections, 13 in type 16 and 5 in type 18, with a proportion of new infections of HPV of 46% for type 16 and 47% for type 18; Figure 1(B). Conclusion: The lack of clearance, high persistence and new high-risk HPV infection in MSM- HIV infected population with high CD4 cell counts and virological suppression, indicates the urgent need of prevention strategies.

663 AGE-SPECIFIC PREVALENCE OF VACCINE-PREVENTABLE ANAL HPV INFECTION IN HIV-INFECTED MSM Alessandra Latini 1 , Maria Gabriella Dona 1 , Manuela Colafigli 1 , Mauro Zaccarelli 2 , Maria Benevolo 3 , Francesca Rollo 3 , Domenico Moretto 1 , Amalia Giglio 1 , Antonio Cristaudo 1 , Massimo Giuliani 1 1 San Gallicano Dermatology Institute, Rome, Italy, 2 Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy, 3 Regina Elena National Cancer Institute, Rome, Italy Background: The availability of prophylactic HPV vaccines provides a unique opportunity to prevent HPV and related diseases in HIV-infected patients, who are particularly susceptible to anal infections and at high-risk for anal cancer. We aimed to assess the age-specific prevalence of the HPV genotypes included in the quadrivalent (qHPV) and nonavalent (nHPV) HPV vaccines in HIV-infected MSM. Methods: HIV-infected MSM (≥18-year-old) attending the HIV/AIDS Unit of the S. Gallicano Dermatological Institute in Rome, Italy, were recruited from September 2009 to March 2016. They were not vaccinated for HPV infection and had no signs or symptoms of ano-genital HPV-related disease. Data on medical history, socio-demographic factors and sexual behavior were collected through face-to face interviews. Anal samples were collected using a Dacron swab and dispersed in PreservCyt (Hologic). HPV-DNA detection and genotyping was carried out using the Linear Array® HPV Genotyping Test (Roche Diagnostics). Results: Three hundred thirteen subjects were eligible. Median age was 41 years (IQR:34-48). Median age at first same sex intercourse was 19 years (IQR:17-22) and the median number of lifetime and recent sex partners were 60 (IQR:20-200) and 3 (IQR:1-6), respectively. At baseline, 88.0% of the patients were on cART, 78.0%were aviremic and the median CD4+ count was 596/mm 3 (IQR: 430-722). Overall anal HPV prevalence was 95.2% (95% CI: 68.2–77.0). At least one of the qHPV types was detected in 49.5% (CI 95%: 43.8-55.2) of the patients, and 71.2% (CI 95%:65.9-76.2) harbored at least one of the types included in the nHPV vaccine. MSM aged 25-29 years harbored the highest prevalence of both qHPV and nHPV types (67.7% and 93.5%, respectively). The lowest prevalence was observed in MSM≥45 years (40.8% and 60.0% for qHPV and nHPV, respectively). A significant linear decrease in the prevalence of both qHPV (chi-square=4.33; p=0.040) and nHPV types (chi-square=14.37; p<0.001) was observed (i.e. from 18-24 age group to ≥45). Conclusion: The prevalence of anal HPV infection among successfully treated HIV-infected MSM is dramatically high. Compared to the qHPV vaccine, a substantially higher proportion of patients could benefit from vaccination with the nHPV vaccine. Based on the observed age-specific distribution of nHPV types, the potential benefits of vaccination appear to be achievable across all ages, but particularly in HIV-infected MSM younger than 30 years of age.

Poster Abstracts

662 CLEARANCE, PERSISTANCE, AND NEW HPV INFECTIONS IN A MEXICAN MSM - HIV COHORT Ofelia M. Rosales Del Real 1 , Rocio Mendez Martinez 2 , Yanink Caro-Vega 1 , Norma E. Rivera-Martínez 1 , Alejandro M. García-Carrancá 2 , Juan Sierra-Madero 1 , Brenda Crabtree-Ramírez 1 1 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 2 Instituto Nacional de Cancerología, Mexico City, Mexico Background: Incidence of anal cancer has been increasing in people living with HIV over the years despite the use of cART. Human Papillomaviruses (HPVs) cause genital warts and cancers in men. Information about the natural history of HPV infection in terms of persistence and clearance in men who have sex with men (MSM) is scarce, and that information is needed for prevention strategies. We aim to estimate the proportiuon of patients with clearance, persistence and new cases of anal HPV infection among MSM population at a tertiary site of care in Mexico City. Methods: From a previous study of HPV prevalence in MSM population conducted in 2008 at “Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán” we invited patients retained in care 9 years after. All participants signed informed consent and answer a sexual risk behavior questionnaire applied also in 2008. We obtained anal exudate to extract DNA and amplified HPV sequences with consensus primers, with subsequent detection of specific types of HPV with commercial kit INNO-LiPA HPV Genotyping Extra II (FUJIREBIO) to compare with previous detection in 2008 in order to determinate persistence, clearance and new infections by HPV serotypes. Descriptive proportions were used to asses clearance, persistence and new cases of specific anal HPV infection in the study population. Results: From the 328 participants in 2008, 275 were retained, 125 were offered to enter to the study and 80 had HPV results. The 80 patients included were on cART had a median CD4 count of 598 cell/mm 3 (RIC 533-693) and 97.5% had viral suppression (defined as <50 copies/mL). Prevalence of any HPV infection increased from 90% in 2008 to 99% in 2017 Detailed HPV infection

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