CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: The prospective, randomized, national, multicenter TECAIN study compared the efficacy of local treatment with 85% trichloroacetic acid to electrocaustic ablation of histologically confirmed AIN in HIV+ since 2015 in Germany. Biopsies of AIN lesions, anal cyto. Swabs and HPV typing were performed at Baseline and follow-up visits. The cyto. findings were divided according to the Bethesda classification. Depending on their oncogenic potential HIV types were distinguished into high risk (HR) and low risk (LR) HPV. The consistencies between HPV types, the cyto. results and histologic findings were analysed. Results: 292 examinations (exa.) in 184 HIV+ included during the TECAIN Study were analyzed until September 12, 2019. At Baseline the median age was 48 years, 98% of HIV+ took antiretroviral therapy and 81%were MSM. Histologically, 108 exa. (37%) showed AIN I as the highest grade HPV-associated lesion, 84 (29%) AIN II and 100 (34%) AIN III. Thus in 184 exa. (63%) HGAIN were detected. At the same time, LSIL diagnosed in 84 (29%), ASC-US in 76 (26%), HSIL in 99 (34%) and negative cyto. results in 33 (11%) cases. Virologically, in 251 cases (86%) at least one HR-HPV could be diagnosed and 28 (10%) LR-HPV. No HPV was detected in 13 (4%) exa.. A cyto. screening found no HSIL in 66.3% of all HGAIN cases. No HR-HPV was detected in 12% of all HGAIN cases. If both cytology and virology results were considered together, only 10.3% of all HGAIN cases showed no higher grade abnormalities. Conclusion: Simultaneous screening with anal cyto. and virological smears detect HGAIN much more reliable than cytology alone (fig. 1). Comparable results in gynecology have led to an extension of routine diagnostics by the addition of HPV typing to cervical cancer screening guidelines in Germany. Fig. 1: Results (n=292) of virological and cytological examinations of all HGAIN cases in the TECAIN RCT and detection rates in simultaneous screening of cytological (C+) and virological (V+) smears. 624 CERVICAL CANCER KNOWLEDGE AND ATTITUDES AMONG HIV-POSITIVE MEN IN MALAWI Corrina Moucheraud 1 , Samuel W. Lewis 1 , Misheck Mphande 2 , Ben Allan Banda 2 , Hitler Sigauke 2 , Paul Kawale 3 , Aubrey Dkangoma 2 , Kathryn Dovel 1 , Alemayehu Amberbir 2 , Agnes Moses 2 , Sundeep Gupta 1 , Risa M. Hoffman 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Partners in Hope, Lilongwe, Malawi, 3 African Institute for Development Policy (AFIDEP), Lilongwe, Malawi Background: Malawi has the greatest cervical cancer burden globally (72.9 cases and 54.5 deaths per 100,000 women), with an elevated risk among HIV-positive women. Malawian women have reported being reluctant to screen without obtaining spousal permission. This study is the first to examine Malawian HIV-positive men’s knowledge and opinions of cervical cancer disease and decision-making around screening, and evaluate associations with women’s screening. The goal is to develop strategies to increase women’s uptake of screening. Methods: A survey was administered at a large, free ART clinic in Lilongwe, Malawi. Male clients (≥18 years) were eligible if they were married and had ever heard of cervical cancer. The survey asked about cervical cancer awareness and perceptions, knowledge of cervical cancer screening and treatment services, and wife’s experiences with screening (primary wife if polygamous). Gender attitudes were measured with the Gender Equitable Men (GEM) scale. Logistic regression was used to identify factors associated with partner screening status. Results: A total of 125 respondents with median age of 44 years (IQR: 39-50 years) were surveyed. Just over half (58%) reported that their wife had ever received cervical cancer screening. Cervical cancer was perceived to be more dangerous than HIV by 78% of men, and 21% reported knowing someone who had died from cervical cancer. When asked who should make decisions about cervical cancer screening, 6% responded their wife only, 55% responded both partners jointly, and 39% responded himself only. Respondents correctly answered an average of 4/8 risk factor questions and 6/8 screening and treatment questions, but knowledge was not associated with whether a

1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 University of California Los Angeles, Los Angeles, CA, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 University of NewMexico, Albuquerque, NM, USA, 5 Tricore Reference Laboratories, Albuquerque, NM, USA, 6 Johns Hopkins University School of Medicine, Division of Infectious Diseases, Washington, DC, USA, 7 Northwestern University, Chicago, IL, USA, 8 University of Pittsburgh, Pittsburgh, PA, USA Background: Risks of non-AIDS defining cancers has increased among people living with HIV since the advent of potent ART. Anal cancer is rare in the general population, but men who have sex with men (MSM) have elevated risk. We evaluated three screening strategies (single anal cytology [aCyt], sequential aCyt, and co-testing [aCyt plus oncogenic HPV]) and their ability to predict anal precancer (anal histological high-grade squamous intraepithelial grade 2+ [hHSIL/AIN2+]) among MSM. Methods: 1027 MSM from the Multicenter AIDS Cohort Study (MACS) had repeated aCyt and HPV testing. Men with abnormal aCyt and a subset with normal aCyt were referred for high-resolution anoscope (HRA). All men had HRA (N=430) within 5 years of their aCyt, 72% of HRAs performed in Pittsburg and LA study sites. Multivariable logistic regression models evaluated risk of AIN2+ within 5 years of screening using the three screening strategies adjusted for age, race, HIV status, number of anal sex partners, and study site. Sensitivity and specificity were calculated among participants who had HRA and results were corrected for potential verification bias (in all participants who had screening tests) using Begg and Greenes’s method. Results: Among those who had HRA tests, the median age at time of HRA was 48 years, 70 %were HIV+, 81% non-Hispanic white, and 9% had CD4 cell count<350 (cells/mm 3 ). Prevalence of AIN2+ was similar among HIV+MSM than HIV- MSM (31% vs 24%, p=0.13), but was higher among the subgroup with CD4<350 (41%, p=0.04). Odds of AIN2+ was significantly higher in those with abnormal screening results with an 83% increase (95% CI: 1.1-3.04) in those with a single aCyt+, a 3-fold increase (95% CI: 1.33-7.11) following two aCyt+, and more than a 4-fold increase (95% CI: 1.93-10.29) following oncHPV+/aCyt+ co-testing. Specificity was low in single aCyt (44%) but increased with sequential aCyt testing (79%) or oncHPV co-testing (62%). Sensitivity was moderate in single aCyt+ (67%) or dual positive cotests (61%), and high in cotests where positivity on either marker was considered as positive (93%). Sensitivity was only 36% among those with sequential aCyt+ results. After correcting for potential verification bias, specificity increased but sensitivity reduced in all strategies. Conclusion: Anal cytology screening had moderate specificity and sensitivity among HIV+ and HIV- MSM. Sequential aCyt testing or adding an HPV co-test to aCyt improved test performance.

Poster Abstracts

623 NEED FOR OPTIMIZATION OF SCREENING METHODS FOR ANAL INTRAEPITHELIAL NEOPLASIA IN PLWH Stefan Esser 1 , Alexander Kreuter 2 , Anja Potthoff 3 , Norbert H. Brockmeyer 3 , Mark Oette 4 , Robert Jablonka 1 , Hildegard Lax 1 , Konstantinos Bilbilis 1 , Laven Mavarani 1 , Karl-Heinz Joeckel 1 , Ulrike Wieland 4 1 University Hospital Essen, Essen, Germany, 2 Helios St. Elisabeth Clinics Oberhausen, Oberhausen, Germany, 3 Ruhr-University Bochum, Bochum, Germany, 4 Cologne University Hospital, Cologne, Germany Background: The detection rate of histologically confirmed high grade anal intraepithelial neoplasia (HGAIN) and anal carcinoma by screening with anal cytological (cyto.) smears and/or human papilloma virus (HPV) typing in HIV- positive individuals (HIV+) has been examined in the TECAIN Study.

CROI 2020 225