CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

617 SUBOPTIMAL IMMUNITY TO HEPATITIS A AMONG NYC MSM INITIATING PrEP OR PEP, 2016-2019 Tarek Mikati 1 , Addie Crawley 1 , Leah Strock 1 , Susan Blank 2 1 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 2 CDC, Atlanta, GA, USA Background: Recent outbreaks of hepatitis A virus (HAV) infection among men who have sex with men (MSM) have occurred globally, nationally, and in New York City (NYC). An estimated critical immunity threshold against HAV is ≥ 70% to prevent outbreaks in MSM populations. National HIV Pre-exposure prophylaxis (PrEP) and post exposure prophylaxis (PEP) guidelines do not recommend HAV serology testing (ST) among MSM for PrEP/PEP initiation. At NYC sexual health clinics (SHC), all patients initiating PrEP or PEP receive HAVST. This analysis aims to determine the prevalence of HAV immunity among MSM initiating PrEP/PEP at SHC and determine subsequent HAV vaccine uptake. Methods: Electronic medical record (EMR) data was extracted for HIV- negative MSM PrEP/PrEP patients who had HAVST for the first time at SHC from September 2016 to March 2019, with a follow up through July 2019. We examined demographics, immunization history and EMR administered vaccines. Patients reactive for HAV IgG were considered immune. Patients were considered vaccinated against HAV if they received at least one dose of HAV vaccine (Havrix™) or two doses of hepatitis A/B combination vaccine (Twinrix™) at SHC (or self-reported vaccination at other clinics). Results: Overall, 4233 MSM initiated PrEP/PEP and had HAVST. Median age was 28 years (IQR 25-33); 32%were Hispanic, 31%were non-Hispanic (NH) white, and 21%were NH Black. Foreign-born were 37% (n=1574). At time of PrEP/ PEP initiation, 26%were diagnosed with bacterial STI’s. Sixty five percent were HAV immune (n=2733). Of 1500 patients not immune, 50% (n=743) received ≥1 dose of Havrix™ (n= 453) or Twinrix™ (n=290) within a year after HAVST. A total of 2437 (58%) patients self-reported receiving hepatitis A vaccination at non-NYC SHC settings; 37% (n=897) were not immune. Conclusion: HAV immunity among this NYC MSM cohort was below the critical immunity threshold against HAV. Subsequent vaccination of this cohort likely increased their immunity to ≥ 70%. HAVST identified a significant number of HAV non-immune patients, despite self-reported hepatitis A vaccination. HAVST for MSM initiating PrEP/PEP and subsequent hepatitis A vaccination of non- immune patients is an effective intervention to prevent future HAV outbreaks. 618 HEPATITIS E RABBIT GENOTYPE INFECTION IN HIV-INFECTED PATIENTS Antonio Rivero-Juárez 1 , Mario Frías 1 , Pedro Lopez-Lopez 1 , Juan Berenguer 2 , Federico García 3 , Juan Macías 4 , Begoña Alcaraz 5 , Angeles Castro 6 , Javier Caballero-Gomez 1 , Antonio Rivero 1 , for the Spanish AIDS Research Network 1 Hospital Universitario Reina Sofia, Cordoba, Spain, 2 Hospital General Universitario Gregorio Marañón, Madrid, Spain, 3 Hospital Universitario San Cecilio, Granada, Spain, 4 Hospital Universitario de Valme, Seville, Spain, 5 Hospital General Universitario Santa Lucía, Murcia, Spain, 6 University Hospital of La Coruña, La Coruña, Spain Background: Among the population in which hepatitis E virus (HEV) infections may have a worse prognosis, HIV-infected subjects represent a high-sensitivity population because of underlying immunosuppression. Our aimwas to assess the prevalence and incidence of HEV in HIV-infected patients in a national cohort and describe the viral strains. Methods: We included HIV-infected patients recruited in the cohort of adult HIV-infected patients of the AIDS Research Network (CoRIS) in follow-up at 26 Spanish hospitals with available serum samples from the centralized BioBank in 2014 and 2015. All samples were tested for HEV IgG and IgM by ELISA (Pharmacy Enterprise© LTD, Beijing, China) and for RNA by qPCR. Samples with detectable HEV viral loads were genotyped following European HEVnet recommendations. Prevalence and incidence of HEV infection were calculated. Results: A total of 845 individuals were included in the study. Seven hundred and fifty-one (88.9%) were male and had a median age of 36.9 years (30.7-45.2 years). At baseline, 101 patients were positive for HEV IgG antibodies (11.9%), none had HEV IgM antibodies, and 2 presented detectable HEV RNA (0.23%). Of the 744 patients with negative HEV IgG antibody at baseline, 733 samples were available for testing during follow-up. Forty-two seroconverted for IgG, supposing a cumulative incidence of 5.7%. One patient was positive for IgM (0.13%), and 2 showed detectable HEV RNA (0.27%)., Viral strains were consistent with genotype 3f. Interestingly, in one patient, the isolated viral strain was consistent with genotype 3ra (Figure 1).

Conclusion: Our study found a relatively high prevalence and incidence of HEV infection in HIV-infected individuals from Spain. We identified one case of infection with the HEV 3ra genotype, the main host of which is rabbit, showing a potential zoonotic role of this emerging genotype in Spain.

Poster Abstracts

619 THE ROLE OF E6/E7 mRNA DETERMINATION FOR ANAL CANCER SCREENING IN HIV-POSITIVE MSM

Ana C. Silva-Klug 1 , Maria Saumoy 2 , Montserrat Torres 3 , Loris Trenti 2 , Sonia Paytubi 3 , Laia Alemany 3 , Isabel Català 2 , Nuria Baixeras 2 , August Vidal 2 , Silvia De Sanjosé 3 , Daniel Podzamczer 1 1 Hospital Universitario de Bellvitge, Barcelona, Spain, 2 Bellvitge University Hospital, Barcelona, Spain, 3 Bellvitge Biomedical Research Institute, Barcelona, Spain Background: To assess High-grade Squamous Intraepithelial Lesions (HSIL) screening strategies that include biomarkers as E6/E7 oncogenes mRNA detection (E6/7-mRNA test) and human papillomavirus (HPV) DNA determination to triage candidates for High Resolution Anoscopy (HRA). Methods: HIV-infected Men who have Sex with Men (MSM) from the ELAVI-67 cohort (NCT03357991) underwent anal smear and HRA with biopsy of suspected dysplasia areas. Anal smear samples were tested by anal liquid-based cytology (aLBC), HPV DNA detection performed by both Linear Array (LA) (37 HPV genotypes) and Hybrid Capture®2 (HC2) (13 High-Risk HPV (HR-HPV) genotypes), and E6/7-mRNA test using Aptima® (14 HR-HPV genotypes). We evaluated two screening strategies that combined aLBC and biomarkers to triage candidates for HRA: 1) aLBC Atypical Squamous Cells of Undetermined Significance (ASCUS) or worse and/or positive biomarker; 2) aLBC HSIL and ASCUS that cannot rule out HSIL (ASC-H) always and aLBC ASCUS and Low-grade SIL (LSIL) only if the biomarker results positive. Results: 354 participants were included, mean age 45.3, mean CD4 count 802.3 cells/mm 3 , 87.3% undetectable viral load. aLBC results: 2.5% inadequate, 49.4% benign, 16.4% ASCUS, 15.8% LSIL, 13% ASC-H and 2.8% HSIL. HRA results: 54% benign, 24.9% LSIL and 21.2% HSIL (HSIL prevalence: 23.7%). Positive result of HPV DNA tests: 90.4% LA, 46.9% LA for the 14 HR-HPV genotypes included in the E6/7-mRNA test, 23.4% LA for HPV-16, 35% LA for HPV-16, -18 and -45 and 40.7% HC2. Positive result of E6/7-mRNA test: 51.7% for all 14 HR-HPV, 16.4% for HPV-16 and 20.3% for HPV-16,-18 and -45. aLBC with a threshold of ASCUS showed 80% sensitivity and 59.3% specificity for biopsy-proven HSIL (AUC=0.617). Sensitivity and specificity of biomarkers alone and in both combined strategies are shown in the table. Comparing the AUC of aLBC with the other AUC showed in the table, a p<0.05 was only found with E6/7-mRNA test in the second combined strategy. Conclusion: E6/7-mRNA test could be considered for triage as an alternative to aLBC with the advantage of being a more objective and reproducible test. The second combined strategy using E6/7-mRNA test only if the aLBC result is ASCUS

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