CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusions: PWH aged 50 years undergoing long-term ART showed increased soluble ICs, endothelial inflammation and hypercoagulable state, increasing the risk of cancer and CVD in the INSTI era. LLV favored an even more exacerbated immunosuppression environment, characterized by a marked increase in sIDO. This inhibitory molecule has been proposed as a prognostic marker for cancer and has also been linked to CVD, consistent with the elevation of Treg cells, sICAM-1 and sCD14 in LLV group. Our findings suggest that IDO could be a promising marker for early detection of future pathologies especially important in LLV population allowing rapid intervention. HPV Detection by Vaginal Self-Sampling and Urine Collection in Women Living With HIV: AUTOCol Study Morgane Mailhe 1 , Mélanie Bertine 1 , Romane Guilbaud 2 , Pauline Manchon 1 , Aline-Marie Florence 1 , Cécile Kedzia 1 , Agnes Villemant 1 , Marie-Aude Khuong 3 , Laurent Blum 1 , Manuella Mireille Onambele Guindi 1 , Cindy Godard 1 , Diane Descamps 2 , Charlotte Charpentier 2 , Jade Ghosn 2 , Valentine Marie Ferré 1 1 Assistance Publique – Hôpitaux de Paris, Paris, France, 2 Hôpital Bichat-Claude-Bernard, Paris, France, 3 CH Delafontaine, Saint-Denis, France Background: Vaginal self-sampling (VSS) has been implemented as the primary cervical cancer screening tool in several countries around the world. Urine collection (UC) can be an alternative if women are uncomfortable with genital sampling. Women living with HIV (WLHIV) are at increased risk of cervical intraepithelial lesions. Methods: AUTOCol is a multicentre prospective study enrolling WLHIV for cervical cancer screening in 4 hospitals from COREVIH IDF Nord. Both VSS (FLOQSwab in Mswab medium, Copan, Italy) and UC (Colli-pee, Novosanis, Belgium) were offered. High-risk human papillomavirus (HR-HPV) were detected with AnyplexII (Seegene, South Korea) by semi-quantitative PCR. Results: Between June 2023 and January 2024, 201 WLHIV with a median age of 51 years (IQR=43-58) were enrolled in the study. Among the 199 WLHIV with available HIV viral load (VL), 91% (n=182) were undetectable (<50 c/mL). Median CD4 T-cell count was 770/mm 3 (IQR=560-990) with 5 WLHIV <200/ mm 3 . The acceptance rate to carry out self-sampling was 87% (n=175). The main reason for refusal was the fear of failing (n=14/26). Patients felt no pain during the UC in 98% of cases (n=156/160) compared to 83% of cases for the VSS (n=140/169), which was uncomfortable for 10% of patients (n=17/169). Patients preferred the UC (n=129/162, 80%) and the VSS (n=128/173, 74%) to the cervical smear performed by a health professional. A total of 174 VSS and 169 UC were collected resulting in 167-paired samples. Both VSS and UC were suitable for HPV detection, with only one unsatisfactory sample in each. On VSS, 75 WLHIV (43%) harbored at least one HR-HPV and of these, 33% (n=25) had multiple infections. HPV68 was the most prevalent type (n=18/174, 10%) and 5% of WLHIV (n=8/174) were positive for HPV16. VSS and UC HR-HPV results showed good agreement (83%, kappa=0.64). Regarding discrepancies between paired samples, 39 HR-HPV from 34 WLHIV were detected in VSS and negative in UC while only 8 HR-HPV in 7 WLHIV were positive in UC and negative in VSS (Fig.1). HR-HPV VL estimation was low for 37 of these 47 discordant HR-HPV (79%). Conclusions: VSS and UC are well accepted by patients and preferred to cervical smear. They are both suitable for HR-HPV detection, but VSS appears to be more sensitive when HR-HPV VL is low. VSS is a good alternative for women who need frequent cervical cancer screening or are reluctant to undergo gynecological examination. UC should only be proposed if women refuse any genital sampling. The figure, table, or graphic for this abstract has been removed.

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The Ivorian Cervical Cancer Screening Cascade: A 10-Year Program Evaluation According to HIV Status Simon Boni 1 , David Goore 2 , Franck Gnahatin 3 , Mesmin Adie 3 , Denise Kpebo 4 , Apollinaire Horo 5 , Innocent Adoubi 3 , Antoine Jaquet 2 , for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration - West Africa 1 PAC-CI Program, Abidjan, Côte d'Ivoire, 2 University of Bordeaux, Bordeaux, France, 3 Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire, 4 Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire, 5 Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire Background: The 2030 global cervical cancer (CC) elimination strategy recommends to achieve a 70% coverage for CC screening and 90% of precancerous lesions treated in eligible women. We evaluated progress towards these WHO CC elimination targets according to HIV status in Côte d’Ivoire over the 2010-2021 period. Methods: A CC screening registry was initiated in Cote d’Ivoire since 2010, collecting standardized individual-level data from all health facilities offering visual inspection with acetic acid (VIA). Initially restricted to the economic capital (Abidjan), the registry progressively expanded to the three most populated administrative regions accounting for almost half of nationwide eligible women. The CC screening coverage was estimated based on the 2021 population census and Spectrum 2023 (HIV national database) in women aged 25-49 years from the general population and in women with HIV (WHIV). CC screening and care cascade indicators were compared according to HIV status, using Chi-square test. Access to same-day cryotherapy/thermal ablation and associated factors were analyzed through a logistic regression model. Results: A total of 66,268 women aged 34 years [IQR: 28-41] in median were screened for CC, 17.0% being WHIV. Overall, the estimated CC screening coverage was 4.4% [95%CI (2.6-5.2)] and 14.8% [95%CI (14.6-15.1)] in WHIV. Among the 4,210 VIA-positive women, 3,500 (83.1%) were eligible for same-day cryotherapy/thermal ablation (83.9% in WHIV). Overall, access to same-day treatment was 59.1% (57.1% in women without HIV and 65.2% in WHIV, p<0.001) but declined over time, particularly in WHIV (Figure) and was higher in those screened in HIV specialized clinics (81.6%) versus HIV-integrated facilities (53.2%), p<0.001). In multivariate analysis, access to same-day treatment was higher in WHIV [aOR= 1.55 [CI: (1.32-1.84)] and women screened in secondary level [aOR=1.82 (CI: 1.49-2.23)] or tertiary level facilities [aOR=1.79 (CI: 1.54 2.09)] compared to primary level facilities. Conclusions: In 2021, CC screening program performances remained particularly low regarding the 2030 CC elimination goals. Access to treatment was unacceptably low, particularly in WHIV, raising the need to improve/ expand integration of cryotherapy/thermal ablation in integrated HIV services and primary healthcare facilities. Overcoming delivery gaps and implement monitoring/tracing strategies for positively screened women is a priority as HPV-based primary screening in being scaled-up in the country.

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Poster Abstracts

CROI 2025 241