CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Maliha Aziz 1 , Daniel Park 1 , Tom De Man 1 , Abigail Onos 1 , Rupert Kaul 4 , Aaron Tobian 5 1 George Washington University, Washington, DC, USA, 2 University of Western Ontario, London, ON, Canada, 3 Rakai Health Sciences Program, Kalisizo, Uganda, 4 University of Toronto, Toronto, ON, Canada, 5 Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Anaerobes in the genital microbiome have been associated with HIV acquisition in both men and women. Prevotella bivia and Dialister micraerophilus are associated with HIV risk and genital inflammation in both men and women despite major differences in vaginal and penile microbiome composition. Little is known regarding the potential transmission of HIV- associated anaerobes, particularly the directionality of transmission. Methods: We characterized sub-preputial microbiota in uncircumcised HIV negative males, including non-sexually active adolescents (aged 15-17 yrs, N=95) and sexually active adult men (mean age 22 yrs, N=47) in Rakai, Uganda. Sub-preputial swabs were collected into 1% BSA in PBS with protease inhibitor. Total bacterial density was measured by qPCR and proportional and absolute abundance of penile bacteria was characterized by sequencing of the 16S rRNA V3V6 region. Overall penile microbiome composition was compared by PerMANOVA test. Prevalence and abundance of penile bacteria were compared by Chi-square test and Wilcoxon rank-sum test, respectively. Results: Penile microbiome composition differed significantly between sexually active and non-sexually active uncircumcised males in both proportion and absolute abundances (PerMANOVA p<0.001 in both). However, the total bacterial density was similar in both groups. Non-sexually active adolescents had high abundances of anaerobic penile bacteria, including many Prevotella and Dialister species; however, the two species associated with HIV risk and inflammation—P. bivia and D. micraerophilus—were significantly less prevalent and abundant in non-sexually active adolescents, in contrast to sexually active men (Chi2 and Wilcoxon p<0.05 for both organisms). Peptostreptococcus anaerobius, associated with HIV risk in men, was also less prevalent and abundant in non-sexually active adolescents (Chi2 and Wilcoxon p<0.05). Other anaerobes—including Porphyromonas and Murdochiella—were more abundant in non-sexually active adolescents than sexually-active men. Conclusion: Prior to initiation of sexual activity, the uncircumcised penile microbiome is dominated by anaerobic bacteria, but the specific species associated with HIV risk and genital inflammation are conspicuously rare. These data suggest that seroconversion-associated anaerobes may originate in the vaginal microbiome, which once when transmitted to penile microbiome could spur foreskin inflammation and colonize the penile microbiome. 1040 PREVALENCE AND INCIDENCE OF STIs DURING PREGNANCY IN SOUTH AFRICA Dorothy C. Nyemba 1 , Phuti P. Ngwepe 2 , Remco P. Peters 3 , Jeffrey D. Klausner 4 , Landon Myer 1 , Dvora Joseph Davey 1 , Andrew Medina-Marino 2 , Leigh F. Johnson 1 1 University of Cape Town, Cape Town, South Africa, 2 University of Pretoria, Pretoria, South Africa, 3 Anova Health Institute, Johannesburg, South Africa, 4 University of California Los Angeles, Los Angeles, CA, USA Background: Global estimates of the prevalence of sexually transmitted infections (STIs) remain high with approximately one million new infections per day. STIs increase HIV acquisition and perinatal transmission risk. Syndromic management for STIs is standard of care in South Africa. We evaluated the incidence and prevalence of STIs in pregnancy in Tshwane District and Cape Town, South Africa. Methods: We conducted two observational prospective studies of pregnant women enrolled while attending their first antenatal clinic (ANC) visit in Cape Town and Tshwane District. We interviewed women ≥18 years and tested them at first ANC visit for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) and Trichomonas vaginalis (TV) using Xpert® assays (Cepheid, USA) as well as at the first postnatal visit. We evaluated the prevalence of STI at first ANC visit and factors associated using logistic regression model. We estimated the incidence of STI and factors associated with time to incident STI using Poisson regression model. Results: We enrolled 669 pregnant women, 427 HIV-infected (64%) from Tshwane District and 242 (36%) from Cape Town (107 HIV-infected and 135 HIV-uninfected). At enrolment, median age was 30 years (IQR 26-34 years) and median gestational age was 18 weeks (IQR 13-23 weeks). Almost all women reported having vaginal sex in pregnancy (89%). At baseline the overall prevalence of any STI was 37% (n=250). The most common infection was CT

(26%) followed by TV (18%), then NG (6%). Overall 11% (n=72) were infected with >1 STI, and 1% (n=7) had all 3 STI infections. Reporting symptoms was not associated with having an STI, 76% participants (n=190) had asymptomatic STI infection. STI infection at baseline was associated with younger maternal age (aOR=0.96, 95% CI=0.92-0.98), gestational age at booking (aOR=1.02, 95% CI=1.00-1.05), single relationship (aOR=1.58, 95% CI=1.13-2.21) and HIV status (aOR=1.91, 95% CI=1.07-3.39) adjusting for site and education. Of the 419 participants who were not infected with an STI at baseline, 21 had an incident STI during follow-up, with mean follow-up time of 81 days. The total incidence rate was 15 infections per 100 women-years (95% CI=9–23) Conclusion: Our study shows high prevalence and incidence of STIs in pregnancy, demonstrating the need for STI screening and treatment in ANC to prevent infant STI and HIV transmission. More research is needed on how to move from syndromic management of STIs in South Africa which misses asymptomatic cases

Poster Abstracts

1041 STILLBIRTH AND PREVALENT SYPHILIS IN THE US WOMEN’S INTERAGENCY HIV STUDY, 1994-2016

Kristal J. Aaron 1 , Ilene Brill 1 , Zenoria Causey 1 , Rachel Sinkey 1 , Lisa B. Haddad 2 , Anandi N. Sheth 2 , Michael Augenbraun 3 , Audrey French 4 , Stephen J. Gange 5 , Kerry Murphy 6 , Dominika Seidman 7 , Barbara Van Der Pol 1 , Jeanne M. Marrazzo 1 , Mirjam-Colette Kempf 1 , Jodie Dionne-Odom 1 1 University of Alabama at Birmingham, Birmingham, AL, USA, 2 Emory University, Atlanta, GA, USA, 3 SUNY Downstate Medical Center, Brooklyn, NY, USA, 4 Rush University, Chicago, IL, USA, 5 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 6 Albert Einstein College of Medicine, Bronx, NY, USA, 7 University of California San Francisco, San Francisco, CA, USA Background: Syphilis rates have increased steadily in US women since 2013 and congenital syphilis cases are at a 20-year high. Syphilis infection during pregnancy can lead to stillbirth. The purpose of this study was to test the hypothesis that prevalent syphilis infection in women with and without HIV can identify those with elevated risk of stillbirth over time. Methods: Women age 16-49 in the multisite US WIHS cohort between 1994 and 2016 with documented syphilis testing and pregnancy outcomes were included. Prevalent syphilis was defined as a positive RPR screen with confirmatory treponemal antibody testing at baseline. Birth outcomes were self-reported with stillbirth defined as an intrauterine fetal demise after 20 weeks of gestational age. History of stillbirth and stillbirth during follow up were examined separately. Logistic regression with backward selection was used to create adjusted models using HIV status, prevalent syphilis and pre- selected covariates. Information about drug use, alcohol intake and sex were collected during biannual visits using standardized questionnaires. Results: The study included 3577 women: 2687 (75%) with HIV and 879 (25%) without HIV. (Fig. 1) Mean age at enrollment was 36 years and prevalent syphilis was more common in women with HIV vs women without HIV (8% vs 4%; p<0.05). In total, 4.6% reported prior stillbirth and 2.2% of women with pregnancy during follow up had stillbirth. During follow-up, 4.7% of women with prevalent syphilis had a stillbirth compared to 2.0% of syphilis seronegative women. Small numbers (n=13) did not permit modeling of stillbirth during follow up. Predictors of prior stillbirth in the unadjusted model (p<0.2) included syphilis at baseline, HIV-negative status, black race, non-heterosexual identity, income <$12000, HCV, older age, lifetime sexual partners, and younger age of sexual debut. In multivariable models, prior stillbirth was associated with syphilis at baseline (OR 1.8, 95% CI 1.0-3.0), HIV- negative status (OR 1.6, 95% CI 1.1-2.2), older age (OR 1.0, 95% CI 1.0-1.1), and younger age at sexual debut (OR 0.95, 95% CI 0.91-0.99). Conclusion: Reported stillbirth rates were four times higher among US women living with and without HIV in this study compared to the general population. Women with prevalent syphilis had higher rates of prior stillbirth and stillbirth

CROI 2020 391