CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

early syphilis if their final disposition indicated they had primary, secondary, or early latent syphilis. We defined a partner as a new HIV case if they had a final disposition code for new HIV diagnosis or a positive HIV lab in the MSDH laboratory database within 30 days after being named as a partner and no evidence of a previous HIV diagnosis in MSDH’s HIV surveillance database. We calculated the number needed to interview (NNTI) as the number of syphilis index cases interviewed divided by the number of new cases of early syphilis or HIV identified among partners. Results: We identified 1619 index cases of early syphilis, of whom 1592 (98%) were interviewed for PS. These index cases named 2267 partners, of whom 1868 (82%) were contacted by MSDH. 1508 (81%) partners were tested for syphilis. 745 (56%) of the 1,321 partners who were not previously HIV diagnosed were tested for HIV. PS identified 696 new cases of early syphilis and 25 new cases of HIV. Overall, 64 index case interviews were needed to identify one new case of HIV among partners, and 2 interviews were needed to identify one new case of syphilis among partners (Table). The NNTI for HIV was lowest among index cases who were HIV positive, men who have sex with men (MSM), or Black/African American. Among those tested for HIV, about 1 in 16 MSM partners of syphilis cases tested newly HIV positive. Conclusion: Syphilis PS allowed MSDH to interact with 1592 MSM over a 30 month period and was effective for identifying new cases of early syphilis and HIV, especially among MSM. Increasing HIV testing among partners of syphilis cases could increase HIV case finding in MS.

Observed differences may be a result of increased incidence among HIV-positive MSM, as well as increased case detection through routine syphilis screening among MSM in HIV care. Similarity between HIV-positive and HIV-negative MSM – lower rate ratios – may indicate areas where there is more sexual mixing among individuals of different HIV serostatus. These findings highlight the intersection between HIV and syphilis and the need to examine local epidemiology to inform targeted interventions.

Poster Abstracts

979 HIGHER RISK AND VULNERABILITY BUT LOWER HIV/SYPHILIS COINFECTION IN THAI TG THAN MSM

Akarin Hiransuthikul 1 , Nanthika Prawepray 2 , Supab Pengpum 2 , Ratchadej Reankhomfu 3 , Phubet Panpet 4 , Nopparat Mahachokchai 4 , Saman Sumalu 5 , Pornpichit Brutrat 5 , Thanthip Sungsing 1 , Jureeporn Jantarapakde 1 , Deondara Trachunthong 1 , Sutinee Charoenying 6 , Praphan Phanuphak 1 , Ravipa Vannakit 7 , Nittaya Phanuphak 1 1 Thai Red Cross AIDS Research Center, Bangkok, Thailand, 2 Sisters Foundation, Chon Buri, Thailand, 3 Caremat Organization, Chiang Mai, Thailand, 4 Rainbow Sky Association of Thailand, Bangkok, Thailand, 5 Service Workers In Group Foundation, Bangkok, Thailand, 6 FHI 360, Bangkok, Thailand, 7 United States Agency for International Development, Washington, DC, USA Background: Men who have sex with men (MSM) and transgender women (TG) are at increased risk for HIV and sexually transmitted infections (STIs). We aimed to determine the differences in prevalence and associated factors of HIV/ syphilis coinfection between HIV-infected MSM and TG. Methods: Thai MSM and TG adults from 6 community-based organizations in Thailand enrolled into a Test and Treat cohort study and completed a baseline demographic, behavior risk assessment, and HIV/STIs testing. Syphilis testing used a 2-step algorithmwith venereal disease research laboratory and if reactive, Treponemal pallidum haemagglutination. Pharyngeal and anal swab, and urine for gonorrhea and chlamydia nucleic acid amplification testing were collected. Logistic regression was used to determine factors associated with HIV/syphilis coinfection. Results: Among 1862 MSM and 787 TG, 17.8% of MSM and 8.9% of TG were HIV-positive (p<0.001), 4.7% of MSM and 0.8% of TG had HIV/syphilis coinfection (p<0.001), 13.2% of MSM and 8.1% of TG had HIV infection only (p<0.001), 5.2% of MSM and 2.8% of TG had syphilis infection only (p=0.006), and 77% of MSM and 88.3% of TG had neither infection (p<0.001). Of 402 HIV-positive participants (332 MSM and 70 TG), 87 MSM (26.2% of HIV-positive MSM) and 6 TG (8.6% of HIV-positive TG) had HIV/syphilis coinfection (p=0.001). Compared to HIV-positive MSM, HIV-positive TG reported more vulnerability and behavioral risk characteristics: lower educational level (87.1% vs 62.2%with high school or less, p<0.001); currently work in entertainment venue (41.8% vs 22.7%, p=0.001); had first sexual intercourse at ≤15 year-old (24.3% vs 14%, p=0.033); had >3 male sexual partners in the past 6 months (54% vs 36.7%, p=0.023); and used non-injected illicit drugs in the past 6 months (49.3% vs 35.5%, p=0.033). However, HIV-positive TG had higher mean baseline CD4 cell count compared to MSM (438 vs 377 cells/µL, p = 0.017). Factors associated with HIV/syphilis coinfection were being MSM (adjusted odd ratio [aOR] 5.67; 95%CI

978 ESTIMATED PRIMARY & SECONDARY SYPHILIS RATES IN MSM BY HIV STATUS – 34 STATES, 2014 Jeremy A. Grey , Elizabeth A. Torrone, Sarah E. Kidd, Kyle T. Bernstein, Hillard S. Weinstock CDC, Atlanta, GA, USA Background: Men who have sex with men (MSM) account for the majority of reported cases of primary and secondary (P&S) syphilis in the United States. In 2016, approximately half of MSM diagnosed with P&S syphilis were known to be living with diagnosed HIV infection; however, because MSM population size and HIV prevalence vary by state, comparing case counts without denominators may not accurately reflect the burden of disease. Thus, we present the first estimates of P&S syphilis rates among MSM by HIV status. Methods: Using national syphilis case report data from 2014, which included information on sex, sex of sex partner(s) and HIV status, we identified the number of reported P&S syphilis cases among MSM by HIV status. We restricted our analysis to 34 states able to classify ≥70% of P&S syphilis cases as women, MSM, or men who have sex with women only. Using state-level population estimates of MSM and estimates of the number of MSM living with diagnosed HIV infection (2014), we calculated state-specific rates of P&S syphilis among MSM living with diagnosed HIV and rates among MSM who are either HIV- negative or who do not know their HIV status. Rate ratios between these two groups were also calculated for each state. Results: In the 34 states included in the analysis, the rate of P&S syphilis among MSM living with diagnosed HIV infection was 8 times the rate among MSM who were HIV-negative/unknown (1,203 vs. 155 per 100,000 MSM). Rates of reported P&S syphilis were higher among MSM living with diagnosed HIV infection in 33 states; one state reported no P&S syphilis among HIV-positive MSM in 2014 (Table). Ratios of reported P&S syphilis rates ranged from 1.5 to 20.9. Conclusion: Rates of P&S syphilis were consistently higher among MSM known to be living with diagnosed HIV compared to MSM not know to be HIV-infected; however, the magnitude of the difference varied substantially across states.

CROI 2018 374