CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Two-state continuous-time Markov models were created separately for HPV 16, HPV 18 and/or 45 (18/45), and any HRHPV combined. Probabilities with 95% confidence intervals (CIs) and duration of HPV infection were estimated using the best-fitted models. Results: The analyses included 87 cisgender men and 4 transgender women, median age 26 years. At baseline, anal HPV 16, HPV 18/45, and any HRHPV were found in 12 (13.2%), 13 (14.3%), and 59 (64.8%) participants, respectively. Two years after HIV acquisition, estimated prevalence rates were 18.4% (95% CI 13.4%–25.5%) for HPV 16, 12.1% (95% CI 8.1%–17.1%) HPV 18/45, and 58.9% (53.1%–64.5%) for any HRHPV. The probabilities of acquiring HPV within two years of HIV acquisition were 40.3% (95% CI 28.7%–53.8%) for HPV 16, 34.6% (95% CI 22.9%–50.7%) for HPV 18/45, and 97.9% (95% CI 93.3%–99.6%) for any HRHPV. The probabilities of HPV clearance within two years of HIV acquisition were 94.3% (95% CI 49.6%–100.0%) for HPV 16, 97.4% (95% CI 90.9%–99.7%) for HPV 18/45, and 92.7% (95% CI 85.2%–97.2%) for any HRHPV. The estimated duration of one episode of infection was 0.70 (95% CI 0.17–2.85) years for HPV 16, 0.55 (95% CI 0.36–0.84) years for HPV 18/45, and 0.77 (95% CI 0.55–1.07) years for any HRHPV. Conclusions: In a cohort with antiretroviral therapy initiation during acute HIV acquisition, the majority of type-specific anal HRHPV infections are likely to spontaneously resolve. However, the probability of acquiring HPV after two years is exceptionally high. This suggests ongoing exposures to HPV among this population. Sexual health consultation, HPV immunization, and anal cancer screening should continue to be recommended for people living with HIV, even years after early antiretroviral therapy initiation.

were 77.3, 94.0, and 90.1 per 100 PY, respectively. Factors associated with HPV related outcomes were having six or more lifetime sex partners, compared to fewer partners, for incidence of HPV 16 (aHR 4.79, 95% CI 1.08–21.35), and being diagnosed with HIV during Fiebig stage 4, compared to stages 1–3, for clearance of HPV 18/45 (aHR 0.14, 95% CI 0.02–0.90) and incidence of other HRHPV (aHR 0.27, 95% CI 0.07–0.96), after adjusting for age and baseline CD4 level. Conclusions: Individuals who acquired HIV and initiated antiretroviral therapy continued to engage in sexual activity, leading to the high rate of HRHPV acquisition over time. The number of lifetime sexual partners was identified as a key predictor of HRHPV acquisition. Even after early antiretroviral therapy initiation regular sexual health consultations, HPV immunization, and anal cancer screening should be strongly encouraged for people living with HIV.

Poster Abstracts

1263 HPV Clearance After Immunization: Investigating Risk Factors Associated With Clearance at Anal Site

Elena Bruzzesi 1 , Federica Gandini 1 , Sara Diotallevi 2 , Riccardo Lolatto 2 , Angelo Roberto Raccagni 1 , Caterina Candela 1 , Girolamo Piromalli 2 , Flavia Passini 1 , Massimo Cernuschi 2 , Silvia Aliverti 2 , Paola Striglia 2 , Andrea M. Tamburini 2 , Roberto Burioni 1 , Antonella Castagna 2 , Silvia Nozza 1 1 San Raffaele Vita-Salute University, Milan, Italy, 2 IRCCS San Raffaele Scientific Institute, Milan, Italy Background: 9-valent HPV vaccine is effective as a prevention tool, rather than therapeutic at cervical site. Insights on viral clearance at anal site is still unknown, especially in the high-risk population of MSM with HIV. Aim of the study is to determine factors associated with the clearance of at least one genotype included in the 9-valent vaccine. Methods: Retrospective cohort analysis in MSM with HIV in care for HIV at the Infectious Diseases Unit of San Raffaele Hospital, Milan, Italy, with ≥2 HPV tests on anal swabs collected 1 before and 1 after immunization with 9-valent HPV vaccine, from 2014 and December 2023 (data lock). Characteristics were determined within 180 days from the date of HPV testing. HPV genotypes are detected by multiplex real-time PCR (CFX96™, Seegene). Multivariable logistic regression is used to estimate risk factors associated with clearance of ≥1 HPV genotype included in the 9-valent vaccine. Results: Among 393 MSM with HIV with at least one HPV test pre immunization, 96 (24.4%) have a subsequent one post-vaccine. At their last HPV test, those who cleared at least one HPV genotype included in 9-valent vaccine were 48 (50%), with a median (IQR) age of 35.1 (31.1-42.5) years, as compared to those who did not [39.9 (34.9-44.1)]. Immuno-virological characteristics were similar among the two groups: overall median CD4 nadir was 410 (285-558) cells/uL with 14.7% with CD4 ≤200 cells/ uL, CD4+ count 787 (614-938.5) cells/uL, CD4/CD8 ratio 1.00 (0.8-1.2), on ART since 7.6 (5.4-10.2) years. Sexually transmitted infections (STI), including syphilis, gonorrhea, mpox, chlamydia, were frequent in both groups: overall, 52 (54.7%) and 19 (20%) had a history or a concomitant STI, respectively. Median time between the two HPV test considered was 1470 (1125-1736) days. Among those with prior positive results, HPV-16 and -18 were cleared in 9/25 and 4/12 MSM with HIV. On the other hand, 11 and 6 had a positivization for HPV-16 and -18.

1262 Incidence and Clearance of Anal Human Papillomavirus Infection in an Acute HIV Cohort in Thailand Supanat Thitipatarakorn, Sujittra Suriwong, Siriporn Nonenoy, Aphakan Klinsukontakul, Jirat Makphol, Piranun Hongchookiat, Thanyapat Chaya Ananchot, Napasawan Chinlaertworasiri, Pravit Mingkwanrungruang, Reshmie Ramautarsing, Nipat Teeratakulpisarn, Nittaya Phanuphak Institute of HIV Research and Innovation, Bangkok, Thailand Background: Anal high-risk human papillomavirus (HRHPV) infection, especially human papillomavirus (HPV) 16, is the leading cause of anal cancer. This study explored factors associated with HRHPV incidence and clearance among individuals with acute HIV acquisition. Methods: Participants who initiated antiretroviral therapy during acute HIV acquisition, defined as Fiebig stages 1–5, and agreed to undergo anal HPV genotyping and high-resolution anoscopy were enrolled at a sexual health clinic in Bangkok, Thailand, from May 2017 to June 2020. Demographic data, sexual history, and baseline laboratory tests were obtained at the time of acute HIV diagnosis. Anal HPV genotyping tests were performed at baseline and 6-monthly visits. Two-state continuous-time Markov models were created separately for HPV 16, HPV 18 and/or 45 (18/45), and HRHPV other than 16/18/45 (other HRHPV). Multivariate analyses were performed by adjusting for age and baseline CD4 level. Results: A total of 87 cisgender men and 4 transgender women, median age 26 years, were included in the analyses. Over 226.6 person-years (PY), the incidence rates of anal HPV 16, 18/45, and other HRHPV were 18.6, 13.7, and 40.3 per 100 PY, respectively. The clearance rates of anal HPV 16, 18/45, and other HRHPV

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