CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

983

Burden of Opportunistic Infections and Causes of Death in Hospitalized Patients With AHD in Vietnam Nam Xuan Ha 1 , Dat Quoc Vu 2 , Dieu Quang Nguyen 3 , Ly Trieu Vo 4 , Thach Ngoc Pham 5 , Cuong Do Duy 6 , Hao Thi Nguyen 1 , Men Thi Trinh 1 , Dao Thi Hong Phan 1 , Chau H. T. Tran 1 , Phuong Le Trinh 3 , Khanh Hoang Dang 3 , Thu Nguyen 7 , H. Rogier van Doorn 8 , Thuy Le 7 , for the Talaromycosis Study Group 1 Oxford University Clinical Research Unit in Vietnam, Ho Chi Minh, Vietnam, 2 Hanoi Medical University, Hanoi, Vietnam, 3 Oxford University Clinical Research Unit in Vietnam, Hanoi, Vietnam, 4 University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam, 5 National Hospital for Tropical Diseases, Hanoi, Vietnam, 6 Bach Mai Hospital, Hanoi, Vietnam, 7 Duke University School of Medicine, Durham, NC, USA, 8 University of Oxford, Oxford, UK Background: Most global AIDS deaths occur in hospitalized patients with advanced HIV disease (AHD), yet data on the major killers among this population are lacking. We investigated the burden of opportunistic infections (OIs) and causes of death in hospitalized patients with AHD in Vietnam to inform policy and intervention strategies. Methods: In this multi-center prospective cohort study, we enrolled patients aged ≥18 years, CD4 count ≤100 cells/ mm 3 or WHO stage 3 or 4 disease from 3 hospitals in Vietnam. In addition to BACTEC blood culture (incubated 5 days) and standard methods to diagnose OIs based on WHO guidelines, we performed the following diagnostics for all patients: 1) Mycobacterial and fungal Myco/F Lytic blood culture (incubated 42 days); 2) Xpert Ultra in blood, and in other clinical specimens as clinically indicated for TB; 3) Fungal antigen tests for cryptococcosis, histoplasmosis, and talaromycosis. Patients were followed up monthly over 6 months to ascertain OI incidence and outcomes. Results: 901 patients were enrolled from 2021 to 2023. The median age was 36.0 years (IQR: 30.0–44.0). 748 (83.0%) were male. The median CD4 count was 19.0 cells/mm3 (IQR: 9.0-45.0). 847 (94.0%) had at least one OI; 217 (24.1%) had two OIs; 439 (48.7%) had greater or equal to three OIs. The leading OIs were: 1) Invasive fungal infections (505, 56.0%), including PCP (37.1%), talaromycosis (19.5%), cryptococcosis (4.7%), histoplasmosis (3.0%); 2) Mycobacterial infections (449, 49.8%), including microbiology confirmed TB (31.7%), clinical TB (16.2%), and non-TB mycobacteria (NTM) (6.3%); 3) Severe bacterial infections (316, 35.1%), including bacterial pneumonia (26.4%) and sepsis (14.2%). The 6-month mortality was 24.2%, with the highest mortality in patients with severe bacterial infections (37.0%), followed by mycobacterial infections (29.4%), and invasive fungal infections (23.2%). The leading causes of death were mycobacterial infections (125, 13.9%), severe bacterial infections (111, 12.3%), and invasive fungal infections (93, 10.3%). 174/218 (79.8%) of deaths occurred within the first 2 months; median time to death was 26 days (IQR: 11.0-58.8). Conclusions: Mycobacterial, bacterial, and invasive fungal infections are the leading causes of AIDS death in Vietnam, claiming lives of 25% of hospitalized patients with AHD. Our data highlight the need for a package of screen and treat strategy targeting these pathogens, and post-discharge interventions to reduce AIDS mortality. The figure, table, or graphic for this abstract has been removed. Patterns of Adiposity and Gestational Weight Gain in Pregnant South African Women Living With HIV Mustafa Shuaib 1 , Jennifer Jao 2 , Hayli Geffen 1 , Helene C. Theunissen 1 , Hlengiwe Madlala 1 , Sandisiwe M. M. Matyesini 1 , Elton Mukonda 1 , Elaine Abrams 3 , Landon Myer 1 1 University of Cape Town, Cape Town, South Africa, 2 Northwestern University, Chicago, IL, USA, 3 Columbia University Irving Medical Center, New York, NY, USA Background: There are concerns that dolutegravir (DTG) may be associated with excess gestational weight gain (GWG) in pregnant women living with HIV (WLH) but there are few data, including from Africa. Methods: The Obesogenic oRigins of maternal and Child metabolic Health Involving Dolutegravir (ORCHID) study is evaluating metabolic outcomes of pregnant WLH receiving tenofovir+lamivudine+DTG (TLD) and HIV-negative (HIV-) pregnant women seeking antenatal care at a primary healthcare facility in South Africa. For this analysis, we included 949 pregnant women (388 WLH, 572 HIV-) enrolled with gestational age (GA) <13 weeks (w) and age >16 years (y). Body composition was assessed using air displacement plethysmography (ADP) and serial standardised anthropometry including triceps, subscapular, and suprailiac skinfold thicknesses to distinguish visceral versus subcutaneous fat distributions. We used latent profile analysis (LPA) to identify adiposity

982

Ceftriaxone or Aqueous Penicillin for Neurosyphilis: A Mexican Multicentric Retrospective Study Rodrigo Ville Benavides 1 , Hector O. Rivera-Villegas 1 , Luz A. Gonzalez Hernandez 2 , Pamela Alatorre-Fernández 3 , Rafael Franco-Zendejas 4 , Estefanía Sienra-Iracheta 5 , Juan Carlos Rodríguez-Aldama 6 , Edgar Pérez-Barragán 6 , Jezer I. Lezama-Mora 7 , Norma Eréndira Rivera-Martínez 8 , Andrea Cárdenas-Ortega 9 , Paulina Carreño-Pérez 10 , Obed Ocampo-Valdez 1 , Jaime F. Andrade Villanueva 2 , Brenda E. Crabtree Ramírez 11 , for the ANTS (Alternative Neurosyphilis Therapy Studies) Group 1 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 2 Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico, 3 Instituto Nacional de Cancerología, Mexico City, Mexico, 4 Instituto Nacional de Rehabilitación, Mexico City, Mexico, 5 Hospital General Dr Manuel Gea Gonzalez, Mexico City, Mexico, 6 Clinica Especializada Condesa Iztapalapa, Mexico City, Mexico, 7 Clinca Especializada Condesa, Mexico City, Mexico, 8 Hospital Regional de Alta Especialidad de Oaxaca, San Bartolo Coyotepec, Mexico, 9 National Institute of Respiratory Diseases, Mexico City, Mexico, 10 Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico, 11 National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico Background: Global syphilis rates are rising, with neurosyphilis (NS) affecting around 4% of syphilis cases. NS is conventionally treated with intravenous penicillin (IV-P) for 10-14 days. However, with global penicillin shortages and limited access to hospital beds in resource-limited settings, timely and adequate treatment is challenging. Alternative treatments like ceftriaxone (C) may be cost-effective, but evidence is scarce. This study aims to compare the efficacy of IV-P versus C in treating NS across multiple sites in Mexico. Methods: In this retrospective multicenter study, we included adult patients treated for NS from 2015-2023 at 9 sites in Mexico (7 in Mexico City, 1 in Oaxaca and 1 in Guadalajara). NS diagnosis required (+) serum RPR or VDRL (≥1:4) with expert confirmation of ocular or otic syphilis, or alternatively, (+) cerebrospinal fluid (CSF) VDRL, pleocytosis or neuropsychiatric (NP) symptoms of NS, excluding other causes. Patients were treated with IV-P (16-24 million U/day) or C (1-2 gr/day IM or IV). We evaluated 2 outcomes at 6 months: early serological response (ESR), defined as a fourfold or greater reduction in serum VDRL or RPR titers, and early clinical response (ECR) as the resolution of ophthalmic, otic, or NP symptoms or pleocytosis. We performed a multivariate LASSO regression analysis to adjust for potential confounders. Results: A total of 201 patients were included: 144 (72%) in the IV-P group and 57 (28%) in the C group. 195 (97%) were male and 191 (95%) had HIV. 92 (48%) had an undetectable HIV viral load (<200c/mL), and the median CD4 was 270 cells/μL. Baseline characteristics were similar between groups. 57 (28%) participants were diagnosed via ophthalmic evaluation alone, 55 (27%) via CSF-VDRL alone, and 108 (53%) by a combination of methods. In univariate analysis, ECR was significantly lower in the C group compared to IV-P: 28% vs 58% [OR:0.27, (95%CI:0.13-0.53), p<0.01]; ESR was more likely in the C group compared to IV-P: 47% vs 42% [OR:1.22,(95%CI:0.65-2.27), p<0.01]. In the LASSO regression model, people with HIV or pleocytosis had a lower likelihood of achieving ESR (AUC 0.65). Similarly, ECR was less likely in patients with advanced HIV or those without ophthalmic evaluation (AUC 0.68). Conclusions: Ceftriaxone was less effective than penicillin for ECR but showed a higher likelihood of ESR. In settings where penicillin is not feasible, ceftriaxone remains a viable alternative, though close clinical monitoring is required. Further studies are warranted.

Poster Abstracts

984

CROI 2025 311