CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

history, behavior, and relationship dynamics. We used descriptive statistics to analyze the data. Results: Of the 50 study participants, the median age was 36.5 (IQR 32-43) years and most (N=49, 98%) were married or living as married with their pregnancy partner. Half (N=26, 52%) reported condomless sex at last sex, N=47 (94%) had HIV-uninfected partners, N=3 (6%) did not know their partners’ HIV-serostatus, and N=46 (92%) disclosed their HIV-serostatus to their partner. Most men (N=48, 96%) accessed ART, and N=8 (16%) had detectable HIV-RNA (>40 copies/mL). Eleven (22%) had curable STIs, including chlamydia-6% and syphilis-16%. Conclusion: Among MLWH planning for pregnancy in rural Uganda, most accessed ART, 92% disclosed their HIV-serostatus to their partner, and 84% were virally suppressed. We also observed a high prevalence of curable STIs, with significant repercussions for the health of men, pregnancy partners, and neonates. Undetectable=Untransmittable (U=U) is an important concept to support men’s reproductive goals. We found that comprehensive counseling and HIV-RNA testing are essential components of the success of U=U. Additionally, as Uganda and other settings consider laboratory-based STI screening, men and women planning for pregnancy should be a screening priority. Integration of comprehensive sexual and reproductive health into HIV care for men and women is critical to cultivating the health of individuals and families living with or affected by HIV. 1046 CHANGES IN SEXUAL RISK BEHAVIORS FOLLOWING AN STI DIAGNOSIS AMONG A COHORT OF MSM Marjan Javanbakht 1 , Amy Ragsdale 1 , E. India Richter 1 , Steven Shoptaw 1 , Pamina M. Gorbach 1 1 University of California Los Angeles, Los Angeles, CA, USA Background: Prevalence of sexually transmitted infections (STIs), rates of STI reinfections, HIV acquisition and changes in behaviors following STIs were examined in a cohort of men who have sex with men (MSM) in Los Angeles, CA. Methods: Data from an NIH/NIDA funded longitudinal study of HIV-positive and high-risk HIV negative MSM participants enrolled from 2014 with at least one follow-up visit through May 2019 were analyzed (n=445; 1,556 study visits; 82% of parent cohort). Study visits every 6 months included computer assisted self-interviews for self-reports of behaviors and urine, pharyngeal and rectal swabs, and blood were tested for chlamydia, gonorrhea, syphilis and HIV. Changes in behaviors following an STI diagnosis were assessed using McNemar’s test for paired data comparing the index visit to each of the follow-up visits. Participants not diagnosed with an STI during the study served as controls for a ‘difference of difference’ analysis of changes over time (difference in change in behaviors among those with no STI compared to difference in change in behaviors among those with an STI). Results: Of the 445 participants, 50% (n=223) were diagnosed with an STI during the course of the study. At the first STI diagnosed visit, the average age was 31 with 41% identifying as Black/African American, 35% Latino/Hispanic, and 15%white. Following an STI diagnosis, significant declines were noted in substance use and sexual risk behaviors (see Table). Among the 91 HIV-negative participants with an STI, six seroconverted during the course of the study (incidence 6.6%). At 12-months post STI diagnosis, binge drinking declined from 50% to 38% (p value<.01), methamphetamine use declined form 50% to 40% (p value=0.03), and median number of sex partners declined from 5 (IQR: 2-12) to 3 (IQR: 1-10)(p value=0.02). No differences were noted overtime in the prevalence of PrEP use. The difference in difference analyses found that those in the STI group were consistently ‘higher risk’ when compared to those with no STIs. Conclusion: STI reinfection in this cohort of MSMwas not uncommon yet was accompanied by some decreases in risk behavior. Because HIV incidence was high and PrEP use low this suggests MSM with STIs occupy a high risk sexual network where even reductions in some risk behaviors do not protect them from ongoing high risk exposures to STIs and HIV.

1 University of North Carolina Project–Malawi, Lilongwe, Malawi, 2 University of the Witwatersrand, Johannesburg, South Africa, 3 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 4 National AIDS Research Institute, Pune, India, 5 Kenya Medical Research Institute, Nairobi, Kenya, 6 Hospital Geral de Nova Iguaçu, Rio de Janeiro, Brazil, 7 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand, 8 Perinatal HIV Research Unit, Soweto, South Africa, 9 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: Sexually transmitted infections (STIs) remain a public health concern because of their interaction(s) with HIV. Infection with STIs among HIV- infected persons may reduce CD4+ level and increase HIV RNA in blood plasma and semen, thus increasing the potential for HIV transmission. In HIV-uninfected individuals, STIs increase genital inflammation that may enhance HIV acquisition during sex. Among both HIV-uninfected and HIV-infected individual, infection with any STI is a marker of unsafe sexual practices. Methods: In the HPTN 052 study, STIs were evaluated in both HIV-infected index cases and their HIV-uninfected partners at enrollment and at yearly follow-up visits. Genital swabs were collected at the sites and shipped to HPTN Central Laboratory for etiology determination. In this analysis, our definition for STI was based on any infection with hepatitis B, Chlamydia trachomatis, Neisseria Gonorrhea, Syphilis, or Trichomonas vaginalis. We used log binomial regression models to identify factors associated with prevalent STIs. Generalized Estimating Equations models with Poisson link function were used to compare STI incidence between HIV-infected index cases and HIV-uninfected partners, stratified by gender. Results: 10.4% of the participants had STIs at enrolment. The prevalence of STIs (13.6 vs 7.2) was higher in HIV-infected index cases compared to HIV-uninfected partners. Being female (prevalence ratio (PR) = 1.29; 95% CI: 1.01 ─ 1.66) or unmarried (PR = 1.61; 95% CI: 1.03 ─ 2.51) was associated with prevalent STIs. STI incidence during follow up is presented in the Table. Compared to HIV- uninfected male partners, HIV-infected female index cases had a higher risk of STI acquisition (Incidence Rate Ratio (IRR) = 2.50; 95% CI: 1.74 ─ 3.60). Conclusion: STIs are common among HIV-serodiscordant couples. HIV-infected female index cases are more likely to acquire STIs from their HIV-uninfected partners or other partners. While we are implementing HIV prevention interventions for HIV-uninfected people, we should also intensify targeted STI prevention interventions, especially among HIV-infected women.

Poster Abstracts

1045 HIV TRANSMISSION RISK FACTORS AMONG MEN LIVING WITH HIV WANTING A PREGNANCY IN UGANDA Pooja Chitneni 1 , Bosco M. Bwana 2 , Moran Owembabazi 2 , Deogratious Tukwasibwe 2 , Alice Najjuma 2 , Johnmary Tumwine 2 , Patricia Smith 3 , Elijah Musinguzi 2 , Cathy Kyampire 2 , Sylvia Natukynda 2 , Paul Kalyebara 2 , Lynn T. Matthews 4 , Angela Kaida3 1 Massachusetts General Hospital, Boston, MA, USA, 2 Mbarara University of Science and Technology, Mbarara, Uganda, 3 Simon Fraser University, Burnaby, BC, Canada, 4 University of Alabama at Birmingham, Birmingham, AL, USA Background: Little is known about HIV risk behavior among men living with HIV (MLWH), who have sex with women, and want to have children. This group is of particular interest given increased HIV acquisition risks to women during periconception and pregnancy periods. We describe HIV transmission risk- factors among a cohort of MLWH planning for pregnancy in rural Uganda. Methods: We enrolled 50 MLWH accessing HIV care and planning for pregnancy with an HIV-uninfected or unknown female partner (Nov 2018-Mar 2019). Men were offered comprehensive safer conception counseling, HIV viral load testing via GeneXpert, and STI testing for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis via GeneXpert, and syphilis via immunochromatographic testing confirmed by rapid plasma reagin. Men also completed a questionnaire on socio-demographics, sexual and reproductive

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