CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Background: In animal models, infection with one strain of Treponema pallidum subspecies pallidum (Tp) protects against reinfection with the same strain, and may or may not protect against infection with a different strain. We sought to determine if the course of syphilis in humans is influenced by prior syphilis. Methods: 897 individuals enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis were categorized as never having had prior syphilis or having ≥1 episode of syphilis before entry. On study, 116 individuals re- enrolled with 1 (n=91) or 2 (n=25) additional episodes of syphilis. Data from the most recent episode were considered. Identification of Tp 16S rRNA in CSF was determined by RT-PCR (n=897), and identification of tp0574 DNA in blood (n=349) by PCR. Associations between categorical variables were assessed using Chi-square or logistic regression. Results: Most participants were middle aged (median 39 yrs., IQR 32-46), HIV-infected (78%), men (97%). Median serum RPR titer for all episodes was 1:64 (1:16-1:128); 50%were treated for uncomplicated syphilis before the study visit. With additional syphilis episodes (0, 1, or 2 repeat episodes on study), %with primary and latent stages increased and %with secondary decreased (P<0.001). In univariate analysis, odds of detection of Tp in CSF were lower in those with prior syphilis before entry, additional episodes of syphilis on study, treatment for syphilis before study visit, and were higher in those with higher serum RPR titer (Table). In multivariate analysis, the odds of detection of Tp in CSF remained lower in those with prior syphilis and in those with additional episodes of syphilis, even after controlling for treatment and RPR titer (Table). Similarly, in univariate analysis, odds of detection of Tp in blood were lower in those with prior syphilis and those treated before study visit, and were higher in those HIV-infected, with higher serum RPR titer, and with early syphilis (Table). In multivariate analysis, the odds of detecting Tp in blood remained lower in those with prior syphilis, even after taking into account HIV, treatment, RPR, and stage (Table). Conclusion: Prior syphilis may prevent dissemination of Tp to blood and CSF during subsequent syphilis. This protection may be lower in HIV-infected persons. A dose-response effect of number of syphilis episodes was seen with Tp detection in CSF, but not blood, perhaps because of smaller numbers.

with doxycycline among HIV-infected patients is limited (Tsai et.al., Plos One 2014; Salado-Rasmussen et.al., Acta Derm Venereol 2016). Methods: In this study, we analyzed serologic response to syphilis treatment with doxycycline among HIV-infected patients treated during a period of penicillin shortage, and compared with treatment response among patients treated with penicillin up to 12 months prior or 6 months after the shortage period. Cases with neurosyphilis and those treated with suboptimal doses or with other medications in association with penicillin or doxycycline were excluded. Results: 61 patients who received treatment with doxycycline from Sep/2014 to Dec/2016 were compared to 60 patients who received treatment with penicillin. Patients treated with doxycycline were slightly older (mean age 49±10 vs 45±9, p=0.0295) and had lower T CD4+ counts (median 544, IQR 403-694 vs 615, IQR 480-864) compared to patients treated with penicillin. Groups were comparable regarding sex, proportions with HIV suppression under treatment, and syphilis stages (Table 1). Serologic response to treatment, defined as a non-reagent VDRL or a 4-fould or higher reduction in VDRL titers measured 6-12 months after treatment, was seem in 67% (95%CI=54-79%) of patients treated with doxycycline and 68% (95%CI=55-80%) of patients treated with penicillin (p=0.895). Conclusion: We found no statistically significant difference in serologic response to treatment with either doxycycline or penicillin among HIV-infected patients with syphilis. Although serologic response to treatment with either doxycycline or penicillin in our study were lower than reported in published studies, our findings indicate that doxycycline is an acceptable treatment alternative to HIV-infected patients with syphilis. 797 INTRAOCULAR TREPONEMA AND TOXOPLASMA INFECTIONS ASSOCIATED WITH BLINDING CATARACTS Juliet Otiti-Sengeri , Colebunders Robert, Lois Bayigga, Rose Nabatanzi, Samuel Kyobe, Damalie Nakanjako Makerere University College of Health Sciences, Kampala, Uganda Background: Visual loss due to cataracts is a common age-related disorder that has been documented among 11.6% of HIV-infected adults in Uganda. Evidence suggests that cataracts occur earlier among HIV-infected adults than among healthy HIV-negative individuals, and may be associated with non- specific intra-ocular inflammatory disease processes. We investigated the role presence of active infection with six common intra-ocular infections, known to contribute to cataract development, among HIV-infected adults that reported for cataract surgery, at an ophthalmology surgical camp in south-western Uganda. Methods: Following written informed consent, all HIV-infected adults that received cataract surgery at an ophthalmology surgical camp, had a detailed preoperative medical and ocular assessment. Individuals with a history of ocular trauma and those with any contraindication to cataract surgery were excluded. Aqueous fluid from all HIV-infected adults that received cataract surgery was analyzed using PCR for the six common opportunistic intraocular infections; Treponema Pallidum (TP), toxoplasma gondii (TG), Herpes simplex 1& 2, Varicella zoster virus (VZV), and Cytomegalovirus (CMV). All patients received adequate postoperative follow up and appropriate therapy was given to those with positive results. Results: Overall, 119 HIV-positive patients received cataract surgery, of whom 70 (59%) were females and 56 (47.1%) were receiving HAART. Mean age was 50 [IQR 43-62) years, and mean CD4 count was 339 (IQR 221-475) cells/µl. Aqueous fluid was positive for Treponema pallidum among 54/119 (45%), positive for toxoplasma gondii among 15/119 (13%), and 50/119 (42%) had no identified pathogen. None was found with positive PCR for CMV, HSVI&II or VZV. Conclusion: Up to 68% of HIV-infected adults with blinding cataracts had intra-ocular pathogens (Treponema pallidum and Toxoplasma gondii). Early diagnosis and treatment of intra-ocular infections, as well as control of non-specific intra-ocular inflammation could prevent or slow development of blinding cataracts among HIV-infected adults. 798 PRIOR SYPHILIS PROTECTS AGAINST T. PALLIDUM DISSEMINATION IN REPEAT INFECTION Christina Marra , Clare Maxwell, Sharon Sahi, Lauren Tantalo, Shelia Dunaway, Sheila Lukehart University of Washington, Seattle, WA, USA

Poster Abstracts

799 HIV REPLICATION AS RISK FACTOR FOR 3 OPPORTUNISTIC INFECTIONS Hansjakob Furrer , University Hospital of Bern, Bern, Switzerland Background: Previous studies have shown that HIV replication is a CD4 independent risk factor for Pneumocystis pneumonia and tuberculosis. We investigated these associations for primary and recurrent events of cytomegalovirus retinitis (CMVR), extrapulmonary cryptococcosis (CRC) and disseminated Mycobacterium avium disease (MAC), and evaluated whether current guidelines for indication of primary and secondary prophylaxis need to be adapted for patients with suppressed HI-viremia. Methods: We estimated the incidence of primary and recurrent events of CMVR, CRC and MAC in patients off primary or secondary prophylaxis in the COHERE database. We used a Poisson generalized additive model with CD4 modelled by a restricted cubic spline and HIV-RNA stratified as low (10’000c/ mL). Results: There were 634 primary MAC events during 859’058 py of follow-up in 131,003 patients, with 81 recurrences during 8’033 py. For CMVR there were 195 primary (74 recurrent) events during 264’532 (6’358) py of follow-up; CRC having 394 (73) events over 861’753 (5’461) py. The figure shows example estimated

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