CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

= -0.75 [-1.81, 0.32]). Probabilities remained stable for all subgroups with the exception of age at infection. The probability of being diagnosed within one year of HIV infection increased for those aged 13-24 years (EAPC = 3.52 [1.50, 5.59]) and decreased for those aged 25-34 years (EAPC = -2.32 [-4.01, -0.59]) and aged 35-44 years (EAPC = -2.26 [-4.44, 0.02]). Conclusion: The percentage of diagnosis of HIV within one year of infection remained stable, leaving room for improvement. A lower probability of diagnosis in the first year of HIV infection can lead to more persons with undiagnosed infection, increasing the opportunity for HIV transmission. To promote early HIV diagnosis and treatment, HIV testing efforts should be intensified for those at risk. 849 INCIDENT STIs AMONG PLWH IN WASHINGTON, DC: MEASURING HIV TRANSMISSION RISK Hana Akselrod 1 , Alessandra Secco 1 , Jose Lucar 2 , Matthew E. Levy 1 , Morgan Byrne 1 , Anne K. Monroe 1 , Michael A. Horberg 3 , Amanda D. Castel 1 , Rupali K. Doshi 4 , Heather Rivasplata 5 , Leah Squires 5 , David Parenti 1 , Debra A. Benator 5 , for the DC Cohort Executive Committee 1 George Washington University, Washington, DC, USA, 2 University of Mississippi, Jackson, MS, USA, 3 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 4 District of Columbia Department of Health, Washington, DC, USA, 5 VA Medical Center, Washington, DC, USA Background: Sexually transmitted infections (STI) are rising nationally and in Washington, DC, which has a generalized HIV epidemic. The DC Cohort study (a city-wide cohort of people living with HIV [PLWH]) previously identified a high proportion of PLWH with HIV viral load (VL) >1500 copies/mL near the time of STI diagnosis, marking potential for HIV transmission. However, the best measure to evaluate HIV transmission risk over time is uncertain. Therefore, we aimed to evaluate STI incidence trends, along with longitudinal and single-point estimates of HIV transmission risk. Methods: We conducted an analysis of DC Cohort data, age ≥18 from 01/2011- 03/2018. STI incidence rates were calculated per 100 person-years and stratified by patient demographics, as well as by STI (gonorrhea, chlamydia, and syphilis). HIV risk was represented by a single-point measure (VL >1500 copies/mL within one month of STI diagnosis) and longitudinal measures (viral load copy-years, and percent time under observation spent with VL >1500 copies/mL, “time >1500”). Results: During a median follow-up of 3.4 years, 786 (9.8%) of 8,021 participants were diagnosed with ≥1 STI episode; of these, 314 (39.9%) had ≥2 STI episodes. The overall STI incidence rate was 5.2 per 100 person-years (95% CI: 5.2, 5.5) and increased from 2012: 3.5 (2.9, 4.2) to 2017: 5.8 (5.1, 6.6) (Figure). The STI incidence rate was highest (p<0.001) in the following groups: age 18-34: 15 (14.0, 16.1), transgender women: 11.4 (9.0, 14.4), Hispanic ethnicity: 11.1 (9.5, 13.0), and men who have sex with men: 10.6 (10.0, 11.2). Among patients with ≥1 STI episode, 13.3% had VL >1500 within one month of STI diagnosis. Among sub-groups, this rate was: 18.7%with VL >1500 among those aged 18-34, 21.5% among cis-gender women, 16.2% among non-Hispanic Blacks, and 18.6% among heterosexuals. Among those with ≥1 STI episode, 33.8% spent some proportion of time with VL>1500 over the period of observation, and median cumulative HIV viral load copy-years was 1.62 (IQR: 0.75, 2.50). Conclusion: An increase in STIs over time was observed among PLWH enrolled in the DC Cohort, consistent with national trends. Triangulation of measures of uncontrolled HIV virus over time, such as “time above 1500” and viral load copy-years, provide improved understanding of HIV transmission risks. Public health interventions should focus on reducing transmission risk and optimizing HIV outcomes in the groups at highest risk for STIs.

Poster Abstracts

850 INFLUENCE OF HIV AND PrEP USE ON HIGH STI PREVALENCES IN MSM IN GERMANY, 2018 Klaus Jansen 1 , Gyde Steffen 1 , Ann-Kathrin Ziesenis 2 , Viviane Bremer 1 , Carsten Tiemann 2 , for the MSM Screening Study research group 1 Robert Koch Institute, Berlin, Germany, 2 Laboratory Krone, Bad Salzuflen, Germany Background: Men who have sex with men (MSM) are disproportionally affected by sexually transmitted infections (STI). Asymptomatic STI can delay diagnosis and treatment. HIV-positive (HIV+) MSM often show even higher STI prevalence. Approval of HIV pre-exposure prophylaxis (PrEP) in Germany in 2016 might have influenced sexual behavior and STI prevalence of HIV-negative (HIV-) MSM. Our aimwas to estimate STI prevalence and risk factors amongst MSM in Germany and compare it systematically by HIV status to plan effective interventions. Methods: We conducted a nationwide, cross-sectional study between 20th February and 2nd July 2018. Thirteen MSM-friendly STI-clinics systematically screened MSM for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhea (NG), and Trichomonas vaginalis (TV) using self-collected rectal and pharyngeal swabs, and urine samples. TMA-based APTIMA® STI-assays were used. We collected information on sociodemographics, HIV- status, clinical symptoms, sexual behavior of the last 6 months and PrEP-use. We combined HIV status and PrEP use for defining risk groups, and used multivariate logistic regression to identify risk factors for STI. Results: 2,303 MSM were included: 50.5%were HIV+, median age was 39 years (range 18-71). Median number of male sex partners was 5 (range 0-820). 57.2% reported unprotected receptive anal intercourse (URAI), and 43.0% use of party drugs. 78.9% had a STI history, 32.1% of STI+MSM reported STI related symptoms. 24.8% (283) of HIV- MSM reported PrEP use. Overall STI prevalence was 25.0% in HIV-/PrEP- MSM (CT: 7.2%; MG: 14.2%; NG: 7.4%; TV: 0%), 40.3% in HIV-/PrEP+MSM (CT: 13.8%; MG: 19.4%; NG: 14.9%; TV: 0.4%), and 30.8% in HIV+MSM (CT: 10.1%; MG: 18.4%; NG: 8.6%; TV: 0.1%). Independent risk factors were HIV/PrEP-status, having >5 sex partners, URAI, and use of party drugs (table 1). Conclusion: We found a high STI prevalence in MSM in Germany, especially in PrEP users. A high proportion of STI+MSM was asymptomatic. Higher STI prevalence in PrEP users than in HIV+MSM could partly be explained by differences in risk behavior. As a relevant proportion of PrEP users will not use a condomwhile using PrEP, comprehensive and highly frequent STI screening is essential and should be available free of charge for PrEP users, which will be

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