CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: We found a high prevalence and incidence of MG in HIV-infected pregnant women in this setting, and a trend towards worse perinatal outcomes in MG-infected women. MG warrants greater attention as part of the growing emphasis on STI diagnosis and treatment in HIV-infected individuals. 1043 DIAGNOSIS OF SEXUALLY TRANSMITTED INFECTIONS IN PREGNANT WOMEN AND MALE PARTNERS Nava Yeganeh 1 , Regis Kreitchmann 2 , Jeffrey D. Klausner 1 , Karin Nielsen- Saines 1 , Mei Leng 1 , Pamina M. Gorbach 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil Background: Porto Alegre, Brazil has the highest rates of congenital syphilis and HIV in the country. Although studies have shown that congenital syphilis and HIV acquisition during pregnancy are associated with untreated sexual partners, male sexual partners infrequently attend clinic for diagnosis and treatment. Other treatable sexually transmitted infections (STIs) including gonorrhea (GC), trichomonas (TV), and chlamydia (GC) are associated with poor pregnancy and neonatal outcomes, but are only diagnosed by syndromic algorithms. Methods: Starting 9/2018, we offered all pregnant women and their male sexual partners clinic-based STI testing for HIV and syphilis( (via lateral flow assay rapid tests provided by the Brazilian Government) and for GC, CT and TV (via PCR-based testing provided by Gene Xpert, Sunnyvale Ca) in 6 public health clinics in Porto Alegre. Participating women and men also answer a brief survey via audio computer assisted survey instrument regarding demographics, partnerships and sexual behaviors. All infected individuals received appropriate treatment and referrals. Results: Of 297pregnant women recruited, 26%were diagnosed with an STI including 2%with HIV, 11.5%with syphilis, 10%with CT, 1%with GC, 5.4% with TV (fig 1). All male partners were invited for evaluation, and 175 (60%) have attended clinic. In these male partners, 14.3%were diagnosed with an STI including 5.2%with syphilis, 8.1%with CT, 1.2%with GC, 1%with TV, and 0.5% with HIV. In our multivariate analysis, younger age (AOR 1.1, 95% CI 1-1.2), being non-white (AOR 2.3, 95% CI 1.3-4.2), having less education (AOR 2.1 95% CI 1.2- 3.7), having a relationship <1 year (AOR 2.3 95% CI 1.2-4), were all independent predictors of women being infected with an STI. Having symptoms of an STI (ulcer, vaginal/urethral discharge) was not predictive of having a diagnosis of STI (OR 0.8, 95% CI 0.5-1.4). The concordance rate of STIs between couples where both were tested ranged from 18% for TV and 75% for CT. Conclusion: STIs are common in pregnant women and are currently not being addressed using syndromic management. Given that most of these infections are easily treatable, they should be appropriately diagnosed and treated in both pregnant women and their sexual partners to decrease treatment failure and re-infection.

during follow-up. Early prenatal care and universal syphilis screening is critical for US women living with HIV or at risk of HIV.

Poster Abstracts

1042 PREVALENCE OF MYCOPLASMA GENITALIUM AND PERINATAL OUTCOMES IN HIV+ PREGNANT WOMEN Dvora Joseph Davey 1 , Remco P. Peters 2 , Carolyn Smullin 1 , Dorothy Nyemba 3 , Hunter Green 1 , Andrew Medina-Marino 4 , Jeffrey D. Klausner 1 , Landon Myer 3 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Anova Health Institute, Johannesburg, South Africa, 3 University of Cape Town, Cape Town, South Africa, 4 Desmond Tutu HIV Foundation, Cape Town, South Africa Background: The bacteriumMycoplasma genitalium (MG) is a sexually transmitted organism that may increase risk of adverse perinatal outcomes, including prematurity and pregnancy loss, but there are few data on the epidemiology of MG in HIV-infected pregnant women in sub-Saharan Africa. Methods: We conducted two observational prospective studies of HIV+ pregnant women receiving antenatal care at two public sector facilities in Tswhane and Cape Town, South Africa. Women self-collected vulvovaginal swabs, tested using the Aptima® Mycoplasma genitalium assay (Hologic, USA). We report on prevalence (both sites) and incidence (Cape Town only) of MG, associated symptoms and perinatal outcomes in HIV+ women and using logistic regression. Results: We enrolled 391 women: 299 from Tshwane (77%) and 92 from Cape Town (23%). Median age was 30 years (IQR=26-35) and gestational age was 18 weeks (IQR=14-23). Most women reported vaginal sex during pregnancy (89%). MG prevalence at first antenatal visit overall was 17% (n=66 of 391): 15% in Tshwane (n=44 of 299) and 24% in Cape Town (n=22 of 92, p=0.04). MG incidence was 5.7 infections per 100-woman-years (95% CI=0.96, 18.9) based on two newly acquired infections. Half of prevalent MG infections had another STI diagnosed at the same visit (50%, n=33) and were treated: Chlamydia trachomatis coinfection in 30% (n=20) and Trichomonas vaginalis in 26% (n=17). Most MG-infected women were asymptomatic (79%, n=52), but vaginal discharge was reported by 6% (n=4), vaginal bleeding in 6% (n=4), and pain with urination in 6% (n=4). Of 299 mono-MG-infected women (not diagnosed with other STIs) with pregnancy outcomes, 33 had adverse pregnancy outcomes including pre-term delivery, stillbirth, or low birth weight. In MG-infected women (n=57), 18% (n=10) of women had an adverse pregnancy outcome compared with 9.5% (n=23 of 242) of MG- women (age adjusted OR=2.03, 95% CI=0.90, 4.54).

1044 SEXUALLY TRANSMITTED INFECTIONS AMONG HIV SERODISCORDANT SEXUAL PARTNERS: HPTN 052 Imogen Kyle 1 , Joseph Kagaayi 2 , Godfrey Kigozi 2 , Gertrude Nakigozi 2 , Robert Ssekubugu 2 , Fred Nalugoda 2 , Mary K. Grabowski 3 , Larry W. Chang 3 , Maria Wawer 2 , David Serwadda 4 , Ronald H. Gray 3 , Thomas Quinn 5 , Steven J. Reynolds 5 , Oliver Ratmann 1 , for the Rakai Health Sciences Program

CROI 2020 392