CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

treatment programs in an HIV hyperendemic Lake Victoria fishing community in Uganda. Methods: We measured prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), syphilis, and herpes simplex virus type 2 (HSV-2) among all consenting adults aged 15-49 participating in the Rakai Community Cohort Study between May and July 2019. CT and NG testing was conducted using nucleic acid amplification testing (Abbott RealTime CT/NG assay). Point-of-care testing was done for TV (OSOM Trichomonas) and syphilis (non-treponemal SDBioline rapid syphilis tests), with subsequent laboratory confirmation of syphilis titers using a rapid plasma regain (RPR) test (Cypress Diagnostics). Participants were classified as having active syphilis infection if their RPR titers were ≥1:8. HSV-2 testing was performed with the Kalon HSV-2 IgG ELISA. Associations of STIs with ART use and male circumcision were estimated using Poisson regression. Results: There were 898 participants, including 435 women (48%), of whom 9% (n=47) were pregnant. There were 398 (40%) who were HIV seropositive. Coverage of ART was 78% (n=301) among HIV seropositive persons and 57% of men (n=264) were circumcised. Overall, there was 8.5% prevalence of NG (n=76), 9.9% CT (n=88), and 12% TV (n=108) (Figure). Syphilis reactivity was 24% (n=216), with 9.4% (n=85) of the total population having titers indicative of active syphilis infection, including 6% of pregnant women (n=3). HSV-2 antibodies were detected in 70% of the population (n=626), including 94% of HIV-positive persons. While prevalence of at least one STI (NG, TV, CT, or active syphilis) was 1.57 fold higher among HIV-positive versus HIV negative persons (34 vs 21% ; 95%CI: 1.20-2.05), there was no differences in STI prevalence by ART status (Prevalence risk ratio [PRR]=0.95; 95%CI: 0.55-1.78) or male circumcision status among all men (PRR=0.93; 95%CI: 0.62-1.38). Conclusion: Despite high coverage of HIV treatment and prevention interventions, the burden of STIs remains extremely high in Lake Victoria fishing communities. There is an urgent need to integrate STI diagnostic testing and treatment with HIV services in these high HIV burdened settings.

sRPR of 128(IQ 64-256) vs 256(IQ 128-1024), median CSF-VDRL 2(IQ 1-2) vs 4(IQ 2-8), and median CSF WBC 71(IQ 29-58) vs 76(IQ 49-131), respectively. Results: Participant characteristics are shown (table); cases and controls were well matched. The AUC was .89(95%CI .81-.97) for the treponemal test and .91(95%CI .84-.99) for the nontreponemal test. We detected CSF treponemal antibodies in 31/36 cases and 5/36 controls, and CSF nontreponemal antibodies in 27/36 cases and 1/36 controls. This resulted in sensitivity of 86% and specificity of 86% for the treponemal test and sensitivity of 81% and specificity of 97% for the nontreponemal test. Treponemal test false negatives and true positives had a median sRPR of 128(IQ 128-384) vs 256(IQ 64-1024), median CSF-VDRL titer of 2(IQ 1-5) vs 4(IQ 2-8) and median CSF WBC 58(IQ 28-213) vs 77(IQ 49-160), respectively. Nontreponemal false negatives and true positives had median sRPR of 128(IQ 64-256) vs 256(IQ 128-1024), median CSF-VDRL 2(IQ 1-2) vs 4(IQ 2-8), and median CSF WBC 71(IQ 29-58) vs 76(IQ 49-131), respectively Conclusion: The diagnosis of NS in RLS is challenging due to the need for modern laboratory facilities, specialized equipment and trained technicians. The DPP® assay can be an option in the point-of-care diagnosis of NS. Further studies should examine its performance in RLS

Poster Abstracts

1051 IDENTIFYING AN HIV AND NEURO/OCULAR SYPHILIS CLUSTER IN VERMONT Devika Singh 1 , Roy Belcher 1 , Daniel Daltry 1 , Abigail Crocker 1 , Jennifer Read 1 1 University of Vermont, Burlington, VT, USA Background: Since 2001, rates of syphilis in the U.S. have more than doubled, largely attributable to an increase among men who have sex with men (MSM). It is recognized that syphilis facilitates HIV acquisition, likely through a combination of biological and behavioral risk factors. National interest in neuro/ ocular syphilis emerged following a cluster of cases in 2014-2015 in Seattle, Washington and San Francisco, California, with the majority of cases occurring among HIV-infected MSM. Our study characterizes a cluster of neuro/ocular syphilis cases among HIV-infected individuals in Vermont in 2017-2018. Methods: All HIV and syphilis diagnostic test results are reported to the Vermont Department of Health (VDH). VDH Disease Intervention Specialists (DISs) conduct interviews with newly diagnosed cases of HIV and syphilis, outreach to all sexual contacts of these cases, and pursue sexual networking analyses. Descriptive statistics were used to summarize population characteristics. Fishers-exact and independent t-tests were used to compare cluster versus non-cluster groups. Results: Between January 1, 2017 and December 31, 2018, 38 newly diagnosed cases of HIV were identified in Vermont. In this cohort, the mean age was 38.2 years and 82%were white, 79%were male, 79%were MSM, 29% had a positive syphilis serology with 11% classified as neuro/ocular syphilis, 21% reported methamphetamine use prior to sex in the past six months, 47% had HIV viral loads > 100,000 copies/mL, and 47% had CD4 cell counts <200/μL. Sexual networking analysis revealed a cluster of ten cases of HIV infection (four diagnosed in rural Vermont counties), of whom seven reported methamphetamine use, nine had viral loads >100,000 copies/mL, seven had CD4 cell counts <200/μL and four had neuro/ocular syphilis. Subjects in the cluster were more likely to have higher HIV viral loads at diagnosis versus those not in the cluster (90%with viral loads > 100,000 copies/mL vs. 33%, p=0.015) There were no other statistically significant differences in characteristics between the two groups. Conclusion: This investigation of newly infected cases of HIV in the rural state of Vermont led to identification of a cluster of cases that appeared more likely to have advanced HIV disease (90%with viral loads > 100,000 copies/mL at diagnosis), and 30% had neuro/ocular syphilis.

1050 A POINT-OF-CARE ASSAY FOR DIAGNOSIS OF NEUROSYPHILIS

Hemil Gonzalez 1 , Christina Marra 2 , Igor Koralnik 1 , Lauren Tantalo 2 , Zachary Orban 1 , Gregory D. Huhn 3 1 Rush University, Chicago, IL, USA, 2 HarborviewMedical Center, Seattle, WA, USA, 3 Ruth M. Rothstein CORE Center, Chicago, IL, USA Background: Neurosyphilis (NS) can cause severe disability. Globally, the burden of NS remains high, and the ability to diagnose it in resource limited settings (RLS) is limited. We tested whether a point of care test originally developed to detect serum treponemal and nontreponemal antibodies could be used on cerebrospinal fluid (CSF) to diagnose NS. Methods: Participant characteristics (table) and ROC curve (figure) are shown; cases and controls were well matched. We detected CSF treponemal antibodies in 31/36 cases and 5/36 controls, and CSF nontreponemal antibodies in 27/36 cases and 1/36 controls. This resulted in sensitivity of 86% and specificity of 86% for the treponemal test and sensitivity of 81% and specificity of 97% for the nontreponemal test. Treponemal test false negatives and true positives had a median sRPR of 128(IQ 128-384) vs 256(IQ 64-1024), median CSF-VDRL titer of 2(IQ 1-5) vs 4(IQ 2-8) and median CSF WBC 58(IQ 28-213) vs 77(IQ 49-160), respectively. Nontreponemal false negatives and true positives had median

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