CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1056 RISK OF PELVIC INFLAMMATORY DISEASE WITH CONTRACEPTIVE METHOD USE IN THE ECHO TRIAL Kavita Nanda 1 , James Kiarie 2 , Khatija Ahmed 3 , Tsungai Chipato 4 , Margaret P. Kasaro 5 , Cheryl M. Louw 6 , Charles S. Morrison 1 , Susan Morrison 7 , Nelly R. Mugo 8 , Maricianah Onono 8 , Thesla Palanee-Phillips 9 , Katherine Thomas 7 , Irina Yacobson 1 , Valentine Wanga 7 , for the ECHO consortium 1 FHI 360, Durham, NC, USA, 2 WHO, Geneva, Switzerland, 3 Setshaba Research Center, Pretoria, South Africa, 4 University of Zimbabwe, Harare, Zimbabwe, 5 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 6 Madibeng Center for Research, Brits, South Africa, 7 University of Washington, Seattle, WA, USA, 8 Kenya Medical Research Institute, Nairobi, Kenya, 9 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa Background: Concerns regarding intrauterine devices (IUDs) and the risk of pelvic inflammatory disease (PID) have been debated for decades. Few data are available from high sexually transmitted infections (STI) settings or have compared PID risk with IUDs with use of other contraceptives. Additionally, previous research is limited by inconsistent definitions, partial or passive follow- up, self-report, and non-randomized comparisons. Methods: We analyzed data from the ECHO Trial, which assessed HIV risk in 7,829 women from 12 sites in sub-Saharan Africa randomized to intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel (LNG) implant, or copper IUD. Women were tested for gonorrhea and chlamydia (NG/CT) at screening. At enrollment, IUDs were inserted without waiting for NG/CT results, but were delayed for at least 7 days after treatment when mucopurulent discharge or cervicitis were seen. Asymptomatic women testing positive for NG/CT were treated once results were available. All participants returned at 1 month for scheduled follow-up visits, and IUD users had routine pelvic exams. Participants in any group who reported abdominal/pelvic pain at any time were examined and treated for presumptive PID based on CDC minimal criteria (abdominal/pelvic pain and either cervical motion, uterine, or adnexal tenderness). We assessed PID incidence over time and compared PID incidence by arm. We conducted sensitivity analyses using specific criteria for PID (minimum criteria plus mucopurulent discharge, friable cervix, or baseline NG/CT). Results: This analysis included 7720 women; median age was 23 years, 24.8 % reported condomless sex in the last 3 months, and 20.9 % had NG/CT at baseline. We diagnosed 405 cases of presumptive PID. PID incidence per 100 woman-years was 1.5, 9.3, and 2.0 among women using DMPA-IM, copper IUD, and LNG implant, respectively. Among copper IUD users, PID rates were higher in the first 30 days after insertion, particularly among women with baseline NG/CT. Conclusion: Our trial found higher rates of presumptive PID among copper IUD users than previously reported, and higher rates among IUD users compared with women using DMPA-IM or LNG implant. Further analyses will evaluate possible diagnostic bias among copper IUD users and the risk of PID after HIV seroconversion.

pooled testing protocol (e.g. using a single elution buffer for all 3 swabs) may further enhance this approach. In addition, future studies should evaluate pooled testing with multiple reference tests to allow for a more precise infection status determination. Future cost analyses should evaluate the cost effectiveness of pooled three-site testing to determine if such a strategy improves the feasibility and accessibility of molecular STI testing in both domestic and international settings. 1055 NO EVIDENCE OF CLINICAL IMPACT OF STIs ON SEMINAL HIV BURDEN DURING SUCCESSFUL ART Christof Stingone 1 , Rossana Scutari 2 , Elisabetta Teti 1 , Lorenzo Piermatteo 2 , Vincenzo Malagnino 1 , Marta Brugneti 2 , Mirko Compagno 1 , Ada Bertoli 2 , Valentina Svicher 2 , Maria M. Santoro 2 , Carlo Federico Perno 3 , Claudia Alteri 3 , Loredana Sarmati 1 , Massimo Andreoni 1 , Francesca Ceccherini Silberstein 2 1 Hospital of Rome Tor Vergata, Rome, Italy, 2 University of Rome Tor Vergata, Rome, Italy, 3 University of Milan, Milan, Italy Background: Sexually transmitted infections (STI) are known to increase the HIV shedding in semen of ART naïve patients. Their role in influencing the seminal compartment despite peripheral undetectable HIV-RNA is still unclear. Methods: This ongoing study includes 25 HIV-1 patients (pts) with undetectable viremia (<20cps/ml) for at least 1year. At enrolment, 10 were STI- positive (cases:7syphilis, 1M.genitalium, 1U.urealyticum urethritis, 1syphilis/C. trachomatis/U.urealyticum co-infection), while 15 were STI-negative. HIV-DNA and residual viremia (detection limits of 32cps/10 6 CD4+ and 2 cps/ ml, respectively) in both blood and seminal compartments by home-made protocols using ddPCR have been analyzed. Results: Pts are mainly MSM (80%), with a median(IQR) age of 37(32-47) years, and median(IQR) CD4+ 772(578-1037) cells/µL. 20 pts were on NRTI- based regimen (3rd drug:11INSTI; 5NNRTI; 4PI), 5 pts were on a dual regimen (2DR):3DRV/c+3TC, 1DRV/r+RAL, 1ETR+RAL. No baseline differences were found between cases and controls. Peripheral HIV-DNA was detectable in 20 pts (80%) with a median(IQR) of 612(154-2571)cps/10 6 CD4+ (table1). Differently, seminal HIV-DNA was detectable only in 3 pts (12%) 1 case and 2 controls, always with a quantification <32cps/10 6 CD4+. Peripheral HIV-RNA was detectable in 16 pts (64%) with a median(IQR) of 2.7(<2.0-4.2) cps/ml, whereas 14(56%) pts had seminal detectable HIV-RNA levels (median[IQR] 3.9[2.1-7.9] cps/ml). In both compartments residual RNA levels never exceeded the 20 cps/ml with the exception of 1 2DR-control (congenital infection) who had 39 cps/ml in the seminal compartment. No differences were found when HIV-DNA and -RNA values in both compartments were compared between cases and controls (p>0.13). However, 6 out of 25pts (24%) showed a seminal HIV-RNA detectability despite the peripheral HIV-RNA undetectability. This discordance was more frequently observed in cases (40%) respect to controls (13%) (p=0.17). 7STI cases were analyzed also after antibiotic treatment and resolution. Among these, seminal HIV-RNA was maintained undetectable or showed a reduction in 6 pts (86%), while only one (16.7%) experienced an increase to 12.1cps/ml.

Poster Abstracts

Conclusion: These preliminary data show that successful combined ART (3DR or 2DR) avoids the presence of HIV-DNA in the seminal cells in the majority of pts, maintaining HIV-RNA in seminal compartment at non-relevant levels, despite STI.

1057 VALIDATING INCIDENT PREGNANCIES AMONG WOMEN USING CONTRACEPTIVES AND ANTIRETROVIRALS Rena Patel 1 , Beatrice Jakait 2 , Gustavo Amorin 3 , Bryan E. Shepherd 3 , Caitlin Bernard 4 , A. Rain Mocello 5 , Beverly Musick 4 , Marisiana A.Onono 6 , Craig R. Cohen 5 , Elizabeth A. Bukusi 6 , Kara K. Wools-Kaloustian 4 , Constantin T. Yiannoutsos 4 1 University of Washington, Seattle, WA, USA, 2 Moi University, Eldoret, Kenya, 3 Vanderbilt University, Nashville, TN, USA, 4 Indiana University, Indianapolis, IN, USA, 5 University of California San Francisco, San Francisco, CA, USA, 6 Kenya Medical Research Institute, Nairobi, Kenya

CROI 2020 397