CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Confirmation of these allele’s roles in the interaction between EFV and implant progestins is needed.

1011 EFFECTIVE TREATMENT OF LYMPHOGRANULOMA PROCTITIS WITH EXTENDED AZITHROMYCIN REGIMEN José L. Blanco , Irene Fuertes, Jordi Bosch, Ana González-Cordón, Esteban Martinez, Andrea Vergara, Teresa Estrach, Jose M. Gatell, Alsina Merçe Hospital Clinic of Barcelona, Barcelona, Spain Background: Lymphogranuloma venereum (LGV) is an ulcerative and among men who have sex with men (MSM) in Western Europe. Current guidelines suggest treatment with Doxycycline 100 mg twice daily for 21 days (DoxLGV). Azithromycin 1 g orally once weekly for 3 weeks (extended azithromycin regimen (EAzLGV)) may be an alternative treatment, and here we investigatedits effectiveness as a treatment for LGV proctitis. Methods: A prospective study was conducted between 2010 and 2017 at the STD Unit of a tertiary referral hospital in Barcelona (Spain). Males over 18 years of age with clinical proctitis,a recent history of unprotected receptive anal intercourse and microbiological confirmation of the diagnosis of LGVwere eligible for inclusion. All patients received a single dose of 1 gr of intramuscular ceftriaxone and were randomly assigned to receive: (i) DoxLGV; or, (ii) EAzLGV. Following treatment, individuals were assessed weekly for clinical symptoms and microbiologically by real-time multiplex polymerase chain reaction (M-PCR) for CT-LGV. Clinical cure (CC) was defined as disappearance of symptoms for at least 12 weeks; and microbiological cure (MC) as a negative rectal PCR for CT-LGV at week 4-6. Results: Of 152 individuals with LGV, 136 (89%) met inclusion criteria. All were MSM with a median age of 38 years (interquartile range 33;44), 46% foreigners and 95% HIV+. Median numbers of sexual partners were 3 [1-10] and 10 [4-37], 5] in the previous 3 and12 months, respectively. Average time between onset of the symptoms and diagnosis was 39 days (range: 1-180). Eleven patients with inclusion criteria were excluded because violation of assigned therapy. From the 136 individuals with proctitis, there were 125 patients left for final analysis, 82 received EAzLGV and 43 received DoxLGV. There were no treatment related adverse events or losses to follow up. CC was achieved in 81 of 82 (99%) vs 41 of 43 (95%) (p= 0,27) and MC in 97% vs 100% (p=1,00) in the EAzLGV and DoxLGV groups, respectively Conclusion: Our findings show that an extended azithromycin regimen was as effective as standard doxicycline regimen and may be considered as an alternative treatment for LGV proctitis in an HIV-infected population of MSM 1012 ADHERENCE OF HEALTH CARE PROVIDERS TO CDC LUMBAR-PUNCTURE CRITERIA AMONG SYPHILIS/HIV Barbara L. Henriques 1 , Vivian I. Avelino-Silva 1 , Marilia B. Antonio 1 , Jose E. Vidal 2 1 Universidad de São Paulo, São Paulo, Brazil, 2 Institute de Infectologia Emilio Ribas, Sao Paulo, Brazil Background: Syphilis is a prevalent infection with increased morbidity and more frequent central nervous system invasion in HIV-infected persons. The CDC suggests laboratory criteria to guide cerebrospinal fluid (CSF) examination among asymptomatic HIV-infected patients. However, information about the degree of adherence to such criteria is scarce. In this study, we describe the proportion of adherence of Health Care Providers to CDC lumbar puncture (LP) invasive sexually transmitted infection (STI) caused by Chlamydia trachomatis (CT) serovars L1, L2, and L3. In the last 15 years it has become hyperendemic

1010 PHARMACOKINETIC AND PHARMACOGENETIC ASSESSMENT OF ART AND CONTRACEPTIVE IMPLANTS Randy Stalter 1 , Jared Baeten 1 , Kimberly K. Scarsi 2 , Bani Tamraz 3 , Katherine Thomas 1 , David Erikson 4 , Jairam Lingappa 1 , Kavita Nanda 5 , Athena Kourtis 6 , Rena Patel 1 , for the Partners PrEP Study Team 1 University of Washington, Seattle, WA, USA, 2 University of Nebraska Medical Center, Omaha, NE, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 Oregon Health and Sciences University, Portland, OR, USA, 5 FHI 360, Durham, NC, USA, 6 CDC, Atlanta, GA, USA Background: Contraceptive implants containing the progestins levonorgestrel (LNG) or etonogestrel (ENG) are highly effective and are increasingly being used by HIV-positive women in Sub-Saharan Africa. However, concomitant use of efavirenz (EFV) reduces implant effectiveness due to induction of cytochrome P450 (CYP450) enzymes. We conducted an analysis among women using implants to evaluate whether EFV use results in lower serum progestin concentrations, and to test whether allele variants with possible links to antiretroviral or hormone metabolismmodify any changes in progestin concentrations. Methods: We included 60 HIV-positive implant users enrolled in the Partners PrEP Study in Kenya and Uganda. Blood samples were collected at 6-month intervals and antiretroviral therapy (ART) initiation was self-reported. We measured serum LNG and ENG concentrations using liquid chromatography- tandemmass spectrometry and genotyped 18 variants in CYP2B6, CYP2A6, CYP3A4, CYP3A5, NR1I2 and ABCB1. We used linear mixed models to calculate geometric mean ratios (GMRs) comparing post-ART to pre-ART progestin concentrations, and to assess for interactions between ART group and allele variants. Multivariable models adjusted for age, nationality, body mass index, closest HIV viral load, days from ART initiation, and implant type. Results: EFV- and nevirapine (NVP)-containing regimens were initiated by 11 and 13 women during the study, respectively; 36 women did not initiate ART and therefore contributed only pre-ART initiation data. In multivariable models, geometric mean serum LNG and ENG concentrations were 61% and 49% lower with EFV use compared to pre-ART initiation, respectively (LNG GMR=0.39, 95% CI: 0.31-0.49; ENG GMR=0.51, 95% CI: 0.34-0.76). GMRs of EFV use vs. pre-ART initiation progestin concentrations were lower with CYP3A5 rs776746 (p=0.009), CYP3A5 rs41303343 (p=0.002), CYP2B6 rs28399499 (p=0.001), and ABCB1 rs1045642 (p<0.001) allele variants relative to the wildtype (Table 1). We found no significant differences in LNG or ENG concentrations, or interactions between ART group and allele variants, with NVP use. Conclusion: Use of EFV but not NVP resulted in lower LNG and ENG concentrations among implant users, and polymorphisms in CYP450 enzyme (CYP3A5 and CYP2B6) and ATP-binding cassette transporter (ABCB1) genes resulted in greater decreases, suggesting a modulating role of genetics.

Poster Abstracts

CROI 2019 396