CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Results: From July 2015 to January 2016, 210/232 (90.5%) participants randomized in the PEP study were tested. MG prevalence at baseline was 10.5% all sites combined (95% CI: 6.6-15.9), and was 6.3%, 4.3% and 0.5% for urine, anal and throat sites, respectively. Ten participants acquired M. genitalium infection at the 6-month visit, 6 participants in the PEP arm (6.7%) and 4 in the no PEP arm (4.9%, p= 0.75). These infections were detected in urine (n=5), anus (n=5) or throat (n=1, combined with anus). The overall rate of MG resistance (prevalent and incident cases) to AZM and FQ was 69.6% and 14.8%, respectively, with no difference between arms (p=1.00 for AZM, p=0.27 for FQ). The MG isolates were resistant by the presence of the substitutions A2058G/T or A2059G in the 23S rRNA and to FQ by the mutations S83I/B, D87Y and A88T in the QRDR of the topoisomerase ParC. Conclusion: The prevalence of MG infection among MSM on PrEP with on demand TDF/FTC was high and its incidence was not decreased by doxycycline prophylaxis with a similar high rate of AZM- and FQ-resistance, raising challenging issues for the treatment of this STI. 967 ASSOCIATION OF PrEP USE AND PAST AND CURRENT STIs AMONG MSM IN WASHINGTON‚ DC‚ 2017 Laura M. Torres 1 , Anya Agopian 1 , Anthony Rawls 1 , Jenevieve Opoku 2 , Manya Magnus 1 , Matthew E. Levy 1 , Michael Kharfen 2 , Irene Kuo 1 1 George Washington University, Washington, DC, USA, 2 District of Columbia Department of Health, Washington, DC, USA Background: While daily, oral pre-exposure prophylaxis (PrEP) reduces HIV transmission risk, there is a growing concern of its potential association with elevated sexually transmitted infections (STIs). It is unclear whether increased STI diagnoses are a result of initial followed by regular STI testing among PrEP users or from an actual increase in risk while on PrEP. We examined the association between PrEP use and past year and current bacterial STIs among men who have sex with men (MSM) in the DC metro area. Methods: We used data from the 2017 National HIV Behavioral Surveillance conducted in Washington, DC. MSM recruited via venue-based sampling completed a behavioral survey and HIV test and provided pharyngeal and rectal swab specimens. HIV-negative MSM who were PrEP eligible were included in the analysis (e.g., reporting condomless anal sex). Participants reported on past year PrEP use and physician diagnosis of either Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in the past year. Current STI (CT and/or GC) was assessed via lab testing of pharyngeal and rectal specimens. Multivariable logistic regression was used to assess the associations between past year PrEP use and past year STIs and also current STI status. Results: Of 275 eligible participants, 41% used PrEP in the past year. PrEP users were more likely to be white and have ³20 partners in the past year. Overall, 25% self-reported a STI diagnosis in the past year, and 13%were currently STI-positive via lab diagnosis. After adjusting for other confounding factors, past year PrEP users were three times as likely to self-report a STI diagnosis in the past year (aPOR= 3.0, 95% CI:1.43, 5.42) compared to non-PrEP users. However, in adjusted analyses, those using PrEP in the past year were not more likely to be currently infected with an oral or rectal STI compared to those not on PrEP (aPOR=1.70, 95% CI: 0.69, 4.3). Conclusion: PrEP use was strongly associated with past year STIs but not with being currently infected, suggesting that being on PrEP may play a role in earlier, active clinical STI screening, diagnosis and treatment. PrEP users regularly interface with the medical system, leading to more opportunities for screening, diagnosis, and treatment, which may have resulted in the lower prevalence of active STIs diagnosed at the time of the survey. Future studies should examine the association of PrEP use with STI diagnosis in conjunction with treatment and use of health services.

968 DETECTED EXTRAGENITAL STI AMONG US MSM BY PrEP STATUS Johanna Chapin-Bardales 1 , Michelle L. Johnson Jones 1 , Robert D. Kirkcaldy 1 , Kyle T. Bernstein 1 , Christi Phillips 1 , John R. Papp 1 , Henry F. Raymond 2 , Jenevieve Opoku 3 , Sarah L. Braunstein 4 , Emma C. Spencer 5 , Salma Khuwaja 6 , Cyprian Wejnert 1 , for the NHBS Study Group 1 CDC, Atlanta, GA, USA, 2 San Francisco Department of Public Health, San Francisco, CA, USA, 3 District of Columbia Department of Health, Washington, DC, USA, 4 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 5 Florida Department of Health, Tallahassee, FL, USA, 6 Houston Health Department, Houston, TX, USA Background: Men who have sex with men (MSM) using HIV pre-exposure prophylaxis (PrEP) may continue to be at high risk for bacterial STIs. We examined the positivity of extragenital gonorrhea and chlamydia among a multisite sample of non-HIV-positive MSM who report using and not using PrEP in the United States. Methods: MSM aged ≥18 years were recruited via venue-based sampling to participate in the 2017 National HIV Behavioral Surveillance. In five cities (San Francisco, Washington DC, New York City, Miami, Houston), participants completed a questionnaire and were offered HIV testing as well as pharyngeal and rectal testing to detect gonorrhea and chlamydia. We estimated the positivity of pharyngeal and rectal gonorrhea and chlamydia among MSM who did and did not report PrEP use in the past year. We also examined PrEP use and STI testing in the past year and condomless anal sex with a male partner at last sex. Results: In the five cities, 553 of 1922 (29%) self-reported non-HIV-positive MSM reported PrEP use in the past year. Compared to those not using PrEP, MSM using PrEP in the past year were more likely to test for STI in the past year (91% vs. 51%, p<0.01) and have condomless anal sex with a male partner at last sex (61% vs. 43%, p<0.01). MSM on PrEP in the past year were slightly more likely to have any gonorrhea or chlamydia detected at any anatomic site (15% vs. 12%, p=0.03), and have rectal chlamydia specifically (9% vs. 6%, p=0.04). MSM on PrEP and those not on PrEP had similar prevalences of pharyngeal chlamydia (1% vs. 1%, p=0.74), pharyngeal gonorrhea (5% vs. 4%, p=0.49), and rectal gonorrhea (3% vs. 4%, p=0.78). Conclusion: The prevalence of extragenital STI was high for both MSM on PrEP and those not on PrEP in the past year. Our findings suggest that men on PrEP may engage in potentially higher risk behavior (condomless anal sex), yet may be screened more regularly for STI. PrEP use was not associated with either pharyngeal STI or rectal gonorrhea; however, men on PrEP were slightly more likely to have rectal chlamydia. Our findings support frequent and regular STI testing as recommended for MSM on PrEP to identify infections and initiate treatment. 969 STI COINFECTIONS DO NOT REDUCE THE PROPHYLACTIC EFFICACY OF CAB LA IN MACAQUES Roopa Luthra 1 , Chunxia Zhao 1 , William Spreen 2 , Chuong Dinh 1 , James Mitchell 1 , Frank Deyounks 1 , Kenneth Sutton 2 , Walid Heneine 1 , Gerardo Garcia-Lerma 1 , Janet McNicholl 1 , Sundaram Ajay Vishwanathan 1 1 CDC, Atlanta, GA, USA, 2 ViiV Healthcare, Research Triangle Park, NC, USA Background: Injectable long acting Cabotegravir (CAB-LA) allows for prolonged dosage intervals and is under evaluation for pre-exposure prophylaxis in women. We have previously shown that CAB-LA fully protected macaques from vaginal SHIV infection. Here, we assessed if CAB-LA efficacy is reduced by genital inflammation. We re-evaluated efficacy in a macaque model

Poster Abstracts

CROI 2019 379