CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1268 Depressive Symptoms on the Incidence of Sexually Transmitted Infections Among Reproductive-Age Women

women with no/primary education (RR 1.47 95% CI 1.22, 1.78) and secondary education (RR 1.22 95% CI 1.05, 1.42) vs those with higher education. There was no difference in CAB efficacy between women who had STIs (hazard ratio, HR, 0.08 95% CI 0.02-0.34) vs those who did not (HR 0.15 95% CI 0.03-0.64, p=0.58). Conclusions: Curable STI prevalence, incidence and recurrence was high in this cohort of women accessing PrEP, highlighting the urgent need to prioritize investments in novel, multipurpose, and scalable interventions to prevent STIs and HIV among these women and their partners.

Paul N. Zivich III 1 , Andrew Edmonds 1 , Michelle Floris-Moore 1 , Catalina Ramirez 1 , Brian W. Pence 1 , Maria L. Alcaide 2 , Deborah L. Jones 3 , Seble Kassaye 4 , Deborah Konkle-Parker 5 , Anandi N. Sheth 6 , Elizabeth F. Topper 7 , Aadia Rana 8 , Daniel Westreich 1 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 University of Miami Miller, Miami, FL, USA, 3 University of Miami, Miami, FL, USA, 4 Georgetown University, Washington, DC, USA, 5 University of Mississippi Medical Center, Jackson, MS, USA, 6 Emory University, Atlanta, GA, USA, 7 The Johns Hopkins University, Baltimore, MD, USA, 8 University of Alabama at Birmingham, Birmingham, AL, USA Background: Prior research has suggested that depressive symptoms may be related to incidence of sexually transmitted infections (STIs) among women, but the patterns have not been consistent and the types of comparisons that have been made are limited. Here, we address this knowledge gap by estimating the dose-response relationship between depressive symptoms and the 6-month incidence of STIs among reproductive-age women with HIV (WWH) and women without HIV (WWoH) but at increased vulnerability to HIV. We project how shifts in the distribution of depressive symptoms might impact STI incidence. Methods: Data for this analysis come from the Study of Treatment and Reproductive Outcomes (STAR) cohort in the United States. Depressive symptoms were measured using the 20-item Center for Epidemiologic Studies-Depression (CES-D) scale. Women who reported a new diagnosis of gonorrhea, syphilis, chlamydia, herpes simplex, or trichomoniasis in the six months following baseline were considered to have an incident STI. We used g-estimation to examine the dose-response between depressive symptoms and STI incidence with inverse probability weights to account for missing STI information. We used g-computation to estimate STI incidence under interventions on the distribution of depressive symptoms. Our statistical analyses adjusted for demographic (e.g., age, education, race, marital status) and behavioral (e.g., history of STIs, condom use, number of sexual partners) variables. Results: Of 851 women enrolled, 308 (36%) had a CES-D score ≥16 at baseline. Among 569 (67%) women with a follow-up visit at six months, 48 (8.4%) reported an STI since their baseline visit. For the dose-response relationship, as depressive symptoms increased, the chance of STI also increased among WWH (Figure). While a CES-D score >30 appeared to increase STI risk relative to a score of zero among WWH, among WWoH greater depressive symptoms did not appear to substantially increase STI risk. A hypothetical intervention that would reduce all women’s CES-D scores by two points was estimated to reduce the incident proportion at six months with STIs by -0.4% (95% confidence interval (CI): -1.2%, 0.4%) relative to the observed incidence. A stronger intervention that reduced CES-D scores by six points would have further reduced the STI incidence (-1.1%; 95% CI: -3.4%, 1.2%). Conclusions: Reducing depressive symptoms among reproductive-age women provides a number of beneficial health effects, one of which may be the reducing the incidence of STIs.

1267 Geospatial Trends of Sexually Transmitted Infections in South Carolina (SC), 2008-2020 Syeda Shehirbano Akhtar, Bankole Olatosi, Buwei He, Shujie Chen, Jiajia Zhang University of South Carolina at Columbia, Columbia, SC, USA Background: The US is experiencing an STI epidemic, with more than one-half of Americans at risk of an STI infection in their lifetime. An all-time high number of STIs was reported in 2021, with the combined number of cases for gonorrhea, syphilis, and chlamydia soaring to 2.54 million. To understand STI incidence among persons with HIV (PWH), we analyzed the incidence rates of chlamydia, gonorrhea, and syphilis by residence, age, race, sex, and associated risk factors from 2008 to 2020. Methods: The study used the South Carolina electronic HIV/AIDS reporting system (eHARS) of all PWH diagnosed with HIV over 12 years. Demographics and clinical data were obtained from the clinical and morbidity datasets. Yearly incidence rates (IR) of each STI (chlamydia, gonorrhea, and syphilis) were calculated as the number of new STI cases per calendar year divided by the total person-time at risk. We defined a new STI diagnosis after the occurrence of HIV in the incidence calculation. For person-time at risk, only PWH diagnosed with HIV on or before each calendar year and alive at the start of that calendar year were included. Results: Incidence rates (IRs) for all STIs showed a significantly upward trend but differed between STIs and subgroups. From 2008 to 2020, the IRs of all STIs increased significantly, with chlamydia representing the highest rates (IR 2008 = 0.42, IR 2020 = 2.59), followed by gonorrhea (IR 2008 = 0.66, IR 2020 = 2.65). Syphilis showed inconsistent trends. Younger individuals (18-30) experienced about a 10-fold increase in chlamydia (IR 2008 = 1.72, IR 2020 = 11.00) and gonorrhea (IR 2008 = 2.52, IR 2020 = 11.53). Syphilis incidence was highest among those aged 30-40 (IR 2008 = 0.86, IR 2020 = 3.61). Males (IR 2008 = 0.76, IR 2020 = 3.40) consistently had more than double gonorrhea rates than females (IR 2008 =0.46, IR 2020 = 0.68). Blacks experienced disproportionately high rates across all three STIs. Men who have sex with men (MSM) recorded the highest STI incidence rate, while Urban residents experienced a significant increase in chlamydia, gonorrhea, and syphilis. Figure 1 shows a map of IRs by county in SC. Conclusions: From 2008 to 2020, the increase in incidence rates of chlamydia, gonorrhea, and syphilis was striking among PWH. These STIs particularly impact young people, Black individuals, MSM, and those in urban areas, highlighting the need for focused and strategic prevention/treatment efforts in these groups.

Poster Abstracts

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