CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1048 ASSOCIATION OF STI DIAGNOSIS WITH INCIDENT HIV IN A SOUTHERN STATEWIDE COHORT Heather N. Grome 1 , Peter F. Rebeiro 1 , Meredith Brantley 2 , Dyanne Herrera- Vasquez 2 , Samantha Mathieson 2 , April Pettit 1 1 Vanderbilt University, Nashville, TN, USA, 2 Tennessee Department of Health, Nashville, Tennessee Background: Data on associations between diagnosis of sexually transmitted infections (STIs) and incident HIV beyond high-risk male subgroups is lacking. Identifying STIs associated with greatest risk of subsequent HIV could help better target HIV prevention interventions such as pre-exposure prophylaxis (PrEP). We hypothesized that some STIs as compared to others may confer a higher risk of subsequent HIV among a large statewide cohort. Methods: Statewide surveillance data in Tennessee (TN) from 1/2013-12/2017 were extracted from the Patient Reporting Investigation Surveillance Manager (PRISM) and the electronic HIV/AIDS Reporting System (eHARS) and matched to identify reportable STI (chlamydia, gonorrhea, all stages of syphilis) and HIV diagnoses among individuals ≥13 years old. Individuals were followed from first STI diagnosis until HIV diagnosis or end of study. Cox regression with time-fixed exposure of STI at cohort entry was used to obtain adjusted hazard ratios (aHR) and associated 95% confidence intervals (CI) for incident HIV. Models accounted for age at time of STI test, sex, race, health department region, reported male- to-male sexual contact (MSM) and history of injection drug use. Results: Over the study period, 148,632 HIV-negative individuals were diagnosed with a reportable STI in TN and followed for 503,298 person- years. Among them, 487 (0.33%) individuals were diagnosed with incident HIV following STI diagnosis, an incidence of 0.97 per 1000 person-years. Chlamydia was the most common STI at cohort entry (n=111,738, 75.3%), though a diagnosis of gonorrhea was most common at cohort entry among those with incident HIV (n=163, 34.5%). Incident HIV infection was 9 times likelier among persons with secondary syphilis as compared to chlamydia (aHR=9.2 95% CI: 6.0-14.1), controlling for demographic and behavioral risk factors. When stratified by self-identified MSM risk, secondary syphilis had greatest association of any STI with subsequent HIV infection among both MSM (aHR=3.2; 95% CI: 1.7-5.8) and non-MSM (aHR=32.8, 95% CI: 16.2-66.6) (Table). Conclusion: Individuals ≥13 years old diagnosed with secondary syphilis were at greatest risk of subsequent HIV infection over the study period compared to those with other reportable STIs in TN, regardless of self-reported MSM risk behavior. These individuals should be especially prioritized for public health efforts and HIV prevention interventions, including PrEP, at the time of STI diagnosis.

1047 VARIATION IN SYPHILIS AMONG BISEXUAL MEN AND ASSOCIATION WITH SYPHILIS IN WOMEN Chase Cannon 1 , Matthew R. Golden 1 , for the CORES Group 1 University of Washington, Seattle, WA, USA Background: The rate of syphilis among U.S. men who have sex with men (MSM) has been rising for over two decades, and rates of syphilis in women and of congenital syphilis are now also increasing. The extent to which these trends are related is uncertain. We evaluated what percentage of MSM early syphilis (ES) cases occurred in men who had both male and female partners (MSMW); how that percentage varied over time and among men of different race/ethnicity and between regions of the U.S.; and the relationship of measures of MSMW syphilis with syphilis rates in women. We hypothesized that the proportion of MSM ES cases occurring in MSMWwould increase over time, would be higher in Black MSM and in the southern U.S., and that measures of syphilis morbidity in MSMWwould be associated with higher syphilis (all stages) rates in women. Methods: We solicited aggregate syphilis surveillance data from areas with the highest rates of ES in 2017, limiting the sample to states with >50 female ES cases and focusing on directly-funded cities if they contributed >50% of cases in their state. The initial sample included 22 jurisdictions, of which 16 (73%) provided data for 2013-2017. ANOVA and linear regression models were used to test hypotheses. Results: Of 122,226 male ES cases from 2013-2017, data on gender of sex partners based on standard syphilis contact periods was available in 77.3%. The median percentages of ES cases in MSM only, men reporting sex with women only (MSW) and MSMWwere 73.6 (range: 49.7-94.2), 14.9 (2.3-37.7) and 7.6 (1.2-26.4), respectively. The mean percentage of MSM ES cases occurring in MSMWwas stable over time, but was higher in the South compared to all other regions, and was higher in Black men compared to White and Hispanic men (p<0.01, Table 1). The mean number of MSMW ES cases per 100,000 men across the five years likewise varied by region, from 5.6 in the South to 2.3 in the Midwest (p<0.01). The rate of syphilis in women was not associated with the percentage of MSM ES cases occurring in MSMW (p=0.18), but was associated with the number of MSMW cases per 100,000 men, with each 10% rise in this number yielding an estimated mean increase in syphilis among women of 0.71 per 100,000 (95% CI: 0.45-0.97). Conclusion: Our findings are consistent with the hypothesis that syphilis rates in women are related to measures of syphilis in MSMW, and may in part explain some observed regional and racial/ethnic disparities in syphilis morbidity.

Poster Abstracts

1049 THE BURDEN OF STIs IN AN HIV HYPERENDEMIC COMMUNITY WITH HIGH ART COVERAGE Mary K. Grabowski 1 , Joseph Kagaayi 2 , Robert Ssekubugu 2 , Jade Jackson 1 , Austin Peer 1 , Godfrey Kigozi 2 , Sarah Kalibbala 2 , Ronald H. Gray 3 , Maria Wawer 3 , Josephine Mpagazi 2 , Stephen Kiboneka 2 , Steven J. Reynolds 4 , Aaron Tobian 1 , Charlotte A. Gaydos 1 , Thomas Quinn 4 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Rakai Health Sciences Program, Kalisizo, Uganda, 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 NIAID, Baltimore, MD, USA Background: Population-level data on sexually transmitted infections (STIs) are rare in sub-Saharan Africa. We measured the prevalence of HIV and five STIs following the roll-out of voluntary medical male circumcision and universal HIV

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