CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

854 ANTIBIOTIC USE AND VAGINAL DISCHARGE SYNDROME BY HIV STATUS IN PREGNANCY: BOTSWANA Modiegi D. Diseko 1 , Sonya Davey 2 , Rebecca Zash 3 , Judith Mabuta 1 , Gloria K. Mayondi 1 , Shahin Lockman 4 , Rebecca Luckett 3 , Chelsea Morroni 5 , Mompati O. Mmalane 1 , Joseph Makhema 1 , Goabaone Mogomotsi 6 , Eldah N. Dintwa 6 , Tumalano Sekoto 1 , Ngozana Seonyatseng 1 , Roger L. Shapiro 7 1 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 2 University of Pennsylvania, Philadelphia, PA, USA, 3 Beth Israel Deaconess Medical Center, Boston, MA, USA, 4 Brigham and Women’s Hospital, Boston, MA, USA, 5 Liverpool School of Tropical Medicine, Liverpool, UK, 6 Botswana Ministry of Health, Gaborone, Botswana, 7 Harvard University, Boston, MA, USA Background: High prevalence of vaginal discharge syndrome (VDS), a clinical diagnosis which may include both non-specific vaginal discharge and sexually transmitted infections (STIs), has been reported among pregnant women in Africa, including in Botswana. We set out to determine whether VDS prevalence or antibiotic treatment differed by maternal HIV status, CD4 cell count, and antiretroviral treatment (ART) use. Methods: We abstracted pregnancy management data from obstetric records for all women who delivered at 8 large government hospitals in Botswana as part of the Tsepamo Birth Outcomes Surveillance Study. Data included all diagnoses made in pregnancy (including VDS and specific STIs when available), antibiotic treatment prescribed, and maternal HIV status. Comparisons were made using Chi-squared analysis on SAS. Results: Between Aug 2014-May 2018, 91383 women delivered at the 8 surveillance sites and 91313 (99.9%) had information on maternal diagnoses in pregnancy. VDS was the most common diagnosis, occurring in 28296 (31.0%) of all pregnancies. Antibiotics were prescribed in 35258 (40.1%) of all pregnancies including in 25596 (90.5%) women diagnosed with VDS. Of 23265 women diagnosed with VDS as their only infection, 18509 (79.6%) were prescribed ceftriaxone, 11723 (50.4%) were prescribed metronidazole, 15317 (65.9%) were prescribed erythromycin/azithromycin, and 9518 (40.9%) were treated according to Botswana guidelines with ceftriaxone, metronidazole, and erythromycin/azithromycin together. There were small differences in the proportion of HIV-positive women and HIV-negative women with any antibiotic use (43.4% vs. 39.1%, p <.0001) and VDS diagnoses (31.7% vs. 31.0%, p=0.04). Among 5654 (25.0%) HIV-positive women with a CD4 cell count recorded in pregnancy, VDS was slightly more common among those with < 350 CD4 cells/ mm3 vs. those with higher CD4 cell counts (37.4% vs. 34.2%, p=0.02). Among 20604 (91.2%) HIV-infected women with known timing of antiretroviral treatment (ART), women initiating ART prior to conception had significantly less VDS than those initiating ART during pregnancy (28.7% vs. 37.8%, p<.0001). Conclusion: Vaginal discharge syndrome is the most common diagnosis among both HIV-positive and HIV-negative pregnant women in Botswana, and the most frequent reason for antibiotic use in pregnancy. Initial univariate analyses suggest that ART started prior to conception may reduce the prevalence of VDS among HIV-infected women. 855 A CASE-CONTROL STUDY OF OCULAR SYPHILIS IN BRITISH COLUMBIA, CANADA, 2010-2018 Hasan Hamze 1 , Venessa Ryan 2 , Emma Cumming 2 , Christine Lukac 2 , Jason Wong 2 , Troy Grennan 2

853 NEISSERIA GONORRHEA INCIDENCE AND TESTING IN THE HIV OUTPATIENT STUDY, 2007-2017

Jun Li 1 , Carl Armon 2 , Frank J. Palella 3 , Richard Novak 4 , Douglas Ward 5 , Stacey Purinton 2 , Marcus Durham 1 , Kate Buchacz 1 1 CDC, Atlanta, GA, USA, 2 Cerner Corp, Kansas City, MO, USA, 3 Northwestern University, Chicago, IL, USA, 4 University of Illinois College of Medicine, Peoria, IL, USA, 5 Dupont Circle Physicians Group, Washington, DC, USA Background: Co-infection with Neisseria gonorrhea (GC) increases HIV transmission. Since 2013, incidence of GC has been increasing in the United States (US). We assessed temporal trends in incidence, testing rates, and associated risk factors among people living with HIV (PLWH). Among PLWH, men who have sex with men (MSM) are at high risk for GC; CDC recommends at least annual testing at 3−6-month intervals for MSM with persistent risk behaviors. We examined levels of up-to-date GC testing and anatomic testing sites among MSM. Methods: We analyzed medical record data from HIV Outpatient Study (HOPS) participants who received care at nine US HIV clinics during 1/1/2007 to 9/30/2017. Incident GC cases were defined based on laboratory results, clinical diagnoses, and treatments. Up-to-date GC testing was defined as having ≥2 GC tests from 10/1/2016 to 09/30/2017. We calculated GC incidence and testing rates during 2007-2017, and assessed associations with sociodemographic and clinical factors using Cox proportional hazards and log-linear regression, respectively. Results: Among 4,727 eligible PLWH, 327 had 852 GC infections during a median follow-up of 6.3 years, with an overall incidence of 2.85 per 100 person-years. GC incidence and testing rates increased by 4- and 3-fold, respectively from 2007-2017. In multivariable analysis, factors associated (p<0.05) with incident GC included younger age, non-Hispanic white race, being MSM, more recent HOPS enrollment, care at private clinics, higher CD4 cell count, and a history of sexually transmitted infections (STIs) (chlamydia, GC, or syphilis). Among MSM (N=1,159), only 583 (50.3%) had GC testing in the prior 12-months (2016-2017), with only 177 (30.4%) having up-to-date testing (Table). Multivariable factors associated with any GC testing among MSM included younger age, non-Hispanic black race, more recent HOPS entry, care at public clinics, being ART-naïve, and having prior STIs. The 583 MSM had 1,428 GC tests during 2016-2017: 68.3% of tests were urine-based only, and 23.5%were all-site (pharynx, rectum, and urethra) with positive rates of 1.6% and 13.4%, respectively (Table). Conclusion: GC incidence and testing rates have increased among US patients in HIV care. However, only half of MSM were tested for GC during 2016-2017 and only one third had up-to-date testing. To promote sexual health and STI prevention among PWLH, including MSM, increases in GC testing across anatomic sites are needed.

Poster Abstracts

CROI 2019 333