CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

(PCPT) and were evaluated retrospectively. Patient charts were analysed for demographic and clinical characteristics, routine laboratory results, therapy (cART/PCPT) information including the third drug, time between start of PCPT and cART, corticosteroid use for severe PCP prior to cART, immunological and virological response data for a 48-week interval and incidence of paradoxical IRIS, following FRENCH’s case definitions (PMID: 15280772). Results were compared between patients with or without IRIS. Fisher’s exact test was used for categorical and Wilcoxon-Mann-Whitney test for numerical variables. Results: IRIS occurred in 12/97 patients (12.4%); significant findings in this group were: higher re-hospitalization rate (41.7% vs. 4.7%; odds ratio [OR] =14.46; p=0.009) and more frequent need for intensive care treatment (66.7% vs. 30.6%; OR=4.54; p=0.018); in-patient treatment duration was longer (median=48 days vs. 23; p 6 log 10 /ml was related to IRIS (41.6% vs. 15.0%; OR=4.05; p=0.042). Serum Immunoglobulin G levels (IgG) [mg/dl] were lower (894.0 vs. 1446.5; p=0.023). A protease inhibitor-sparing cART (63.6% vs. 27.4%; OR=4.64; p=0.023) and lack of corticosteroid use prior to cART were significantly associated with IRIS (25.0% vs. 2.4%; OR=13.83; p=0.013). There were no significant differences regarding other parameters including death, CD4 count or time between start of PCPT and cART. Conclusion: Hospitalization and morbidity parameters underscore the clinical relevance of PCP-related paradoxical IRIS. A viral load of > 6 log 10 /ml and serum IgG may previously help to assess the individual risk for IRIS. However, this analysis supports the use of protease inhibitors and corticosteroids, in order to reduce the incidence of PCP-IRIS. No adverse respiratory effects due to early cART initiation or steroid use were observed.

794 ANTIFUNGAL DRUG SUSCEPTIBILITY OF TALAROMYCES MARNEFFEI CLINICAL ISOLATES, GUANGDONG Linghua Li , Wanshan Chen, Fengyu Hu, Xiejie Chen, Weiping Cai, Xiaoping Tang Guangzhou Eighth People’s Hospital, Guangzhou, China Background: Talaromyces marneffei can cause a fatal systemic mycosis in AIDS patients in Southeast Asia and Southern China. In Guangdong, the number of case is increasing, with many patients remain culture-positive after two weeks of antifungal therapy. We aim to investigate the antifungal susceptibility of T. marneffei strains with preliminary analysis of clinical correlation to inform treatment strategies. Methods: 192 T. marneffei strains were obtained from bone marrow or peripheral blood of AIDS patients admitted at Guangzhou Eighth People’s Hospital, the largest AIDS hospital in Guangdong. All isolates were identified by conventional culture, microscopic characteristics, and ITS sequencing. Blood and bone marrow culture were obtained before antifungal therapy, followed by blood culture weekly and bone marrow culture every two weeks until cultures became negative. Trains were categorized into two groups according to culture status at two weeks. The profiles of antifungal susceptibility at the yeast phase were generated using the Sensititre YeastOneTM YO10 assay, and the frequency of high MICs were compared between the groups using Chi Square test. Results: Strains from 192 patients were collected from 2013 to 2016. 145/192 (76%) patients were male. The median age was 36 years. The median CD4 cell count was 9 cells/mm 3 . 85 patients received amphotericin B; 46 received itraconazole, and 78 received voriconazole for a median duration of 30 days. The differences in gender, age, CD4 count, antifungal duration, and antifungal drugs between the two groups were not statistically significant (all P>0.05). The baseline MICs from low-to-high were as follows: posaconazole and voriconazole ≤0.008−0.06 μg/ml, itraconazole ≤0.015−0.03 μg/ml, amphotericin ≤0.25−1 μg/ml, anidulafungin 4−8 μg/ml and caspofungin 2−8 μg/ml, micafungin >8 μg/ml, and fluconazole 1−16 μg/ml. 89 strains were culture-negative at two weeks (Group A) and 103 strains were culture-positive (Group B). Group B had higher proportion of isolates with MICs above 0.015 (χ2=4.819, P=0.028) for voriconazole, and MICs above 4 (χ2=8.945, P=0.003) for fluconazole. Conclusion: The T. marneffei isolates from Guangdong are susceptible to posaconazole, voriconazole, itraconazole, and amphotericin B but are resistant to the echinocandins and fluconazole. Persistent culture positivity is seen in isolates with higher MICs against azole drugs. 795 RISK FACTORS FOR IRIS IN HIV-ASSOCIATED PNEUMOCYSTIS PNEUMONIA AFTER ART INITIATION Gerrit Kann , Hannah Bielke, Philipp De Leuw, Gundolf Schuettfort, Annette E. Haberl, Junaid Owasil, Claus P. Kuepper-Tetzel, Nils Wetzstein, Imke Wieters, Johanna Kessel, Markus Bickel, Pavel Khaykin, Christoph Stephan University Hospital Frankfurt, Frankfurt, Germany Background: HIV-infected patients with Pneumocystis-pneumonia (PCP) due to Pneumocystis jirovecii-infection may develop immune reconstitution inflammatory syndrome (IRIS), following combination antiretroviral therapy (cART)-initiation. Though starting cART early is standard of care, PCP-associated IRIS could counteract its benefit. The aim of this study was to identify possible predictors and susceptible risk factors. Methods: Frankfurt HIV Cohort patients with PCP were identified by hospital database query between January 2010 and June 2016. Among 108 individuals with HIV-associated PCP, 97 started off cART in the course of PCP-treatment

Poster Abstracts

796 NATURAL EXPERIMENT OF SYPHILIS TREATMENT WITH DOXYCYCLINE IN HIV-INFECTED PATIENTS Marilia B. Antonio , Ricardo d. Vasconcelos, Gabriel Trova, Vivian I. Avelino- Silva Universidad de São Paulo, São Paulo, Brazil Background: Although doxycycline is considered an alternative to penicillin as treatment option for syphilis, data on serologic response following treatment

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