CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

number needed to test was 6.7 participants to diagnose one STI. In men, the addition of LE testing reduced this to 2.8 participants. Conclusion: In our population of adolescents living with HIV, STIs were heterogeneously distributed, and highest in 20-24 year old females demonstrating significant gender based disparity. Syndromic screening alone demonstrated poor predictive utility for diagnosing CT and/or NG particularly in women; however, LE performed better, especially in men. Risk factor assessment and screening tests can guide targeted testing to reduce the number needed to screen to identify CT and NG among 15 to 24 year olds living with HIV.

1004 INCIDENCE OF HSV-2 AND HIV IN A COHORT OF KENYAN ADOLESCENT GIRLS Alison C. Roxby 1 , Amalia Magaret 1 , Stacy Selke 1 , Murugi Micheni 2 , Lynda M. Oluoch 2 , Tiffany Yuh 1 , Bhavna Chohan 2 , Catherine Kiptinness 2 , Kenneth Ngure 2 , Nelly R. Mugo 2 , Anna Wald 1 1 University of Washington, Seattle, WA, USA, 2 Kenya Medical Research Institute, Nairobi, Kenya Background: Herpes simplex virus-2 (HSV-2) infection is a powerful cofactor for HIV acquisition in sub-Saharan Africa. Young women acquire HSV-2 and HIV earlier than men, but individual factors influencing HSV-2 incidence are not known. HSV-2 acquisition may be a modifiable risk factor for reducing HIV incidence. Methods: Adolescent girls aged 16-21 were recruited at a suburban clinic in Thika, Kenya. Eligible participants were both HIV and HSV-2 seronegative and reported either sexual naiveté or having had one lifetime sexual partner. Girls under age 18 needed parental consent to participate. Quarterly testing was done for incident HIV-1 by ELISA and HSV-2 by the Focus ELISA test. HSV-2 PCR testing of genital swabs was also done quarterly to detect infection as early as possible. Incident HSV-2 infections were confirmed by Western blot. Girls were provided comprehensive reproductive health care including STI screening, contraception, condoms, and more recently, access to PrEP. We assessed potential associations of baseline characteristics with HSV-2 seroconversion using Fisher’s exact test for dichotomous measures and Wilcoxon rank-sum test for continuous measures. Results: We enrolled 400 participants with a median age of 18.6 years (IQR 16-21). The majority (322 girls, 80.5%) reported no history of sexual intercourse, while 78 (19.5%) reported sex with 1 lifetime partner. Over 4 years, with a median follow-up of 33 months per person, we detected 19 cases of HSV-2 and 2 cases of HIV. Incidence of HSV-2 was 21 cases per 1000 person/years (py); 45 per 1000 py among those with any STI at baseline and 16 per 1000 py among those without. For HIV, incidence was 2 cases per 1000 py. HSV-2 seroconversion was significantly associated with higher Nugent score at baseline (p=0.028), and there was a trend toward association for girls with baseline detection of STIs (p=0.058) and baseline diagnosis of bacterial vaginosis (p=0.072). Similar to other adolescent cohorts, some participants with STIs denied having sexual intercourse. Conclusion: We present the first estimates of HSV-2 incidence in a cohort of sexually naïve young women followed over four years in Kenya. Higher Nugent scores and presence of other STIs were significantly correlated with incident HSV-2. Interventions to prevent STIs and promote healthy vaginal microbiota could influence HSV-2 acquisition in this age group.

Poster Abstracts

1003 PREVALENCE AND DETERMINANTS OF STI IN HIV+ AND HIV- PREGNANT SOUTH AFRICAN WOMEN Dvora Joseph Davey 1 , Dorothy Nyemba 2 , David DiTullio 1 , Yolanda Gomba 2 , Jeffrey D. Klausner 1 , Landon Myer 2 1 University of California Los Angeles, Los Angeles, CA, USA, 2 University of Cape Town, Cape Town, South Africa Background: Sexually transmitted infections (STI) increase HIV acquisition and transmission risk during pregnancy. Syndromic management is standard in many settings, but there are few data on the occurrence of STI in HIV-infected and uninfected pregnant women. Methods: We conducted a cross-sectional study of pregnant women attending a public sector antenatal clinic (ANC) in Cape Town, South Africa. Separate from routine care, after first antenatal care (ANC) visit women ≥18 years were interviewed and self-collected vulvovaginal swabs that we tested for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) and Trichomonas vaginalis (TV) using Xpert® assays (Cepheid, Sunnyvale, USA). We used multivariate logistic regression to identify factors associated with having a STI by HIV serostatus. Results: In 241 women (median age 29 years [IQR=24-34], median gestation 19 weeks [IQR=14-24]) 44%were HIV-infected of whom 33% started ART at their first ANC visit. 47% of women were married/cohabiting. Almost all women reported vaginal sex during pregnancy (93%), 1% reported >1 partner in the past 12 months and 3% reported anal sex during pregnancy. Prevalence of any STI was 32%; 38% in HIV-infected women vs 28% in HIV-uninfected women (p=0.078); the prevalence of individual and co-infections was consistent by HIV status (Figure). STI-related symptoms in women diagnosed were reported infrequently (4% vaginal bleeding; 13% abnormal discharge; 6% dyspareunia). Of women with STI detected, 1%were diagnosed syndromically during routine ANC; this proportion did not vary by HIV status. In a multivariable model controlling for gestational age and relationship status, HIV+ status (adjusted odds ratio [aOR]=1.86; 95% CI=1.01-3.43), younger age (aOR=0.95/year; 95% CI=0.90-0.99) and suspecting partner of having other partners (aOR=1.68; 95%CI=1.00-3.10) were independently associated with STI detection. STI symptom(s) in pregnancy were not predictive of STI diagnosis (age-adjusted OR=0.58; 95% CI=0.28-1.21; p=0.15) and this did not vary by HIV status. In HIV-infected women, younger age was associated with increased odds of STI diagnosis (aOR=0.89/year; 95% CI=0.82-0.96). Conclusion: We document a very high prevalence of treatable STIs in pregnancy in both HIV-infected and -uninfected women in this setting. Symptoms were not predictive of infection; novel approaches to improve STI diagnosis and management in pregnancy are urgently required.

CROI 2019 393