CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Results: Eight-hundred and ninety two patients were included at baseline. Of them, 188 (21.07%) showed positive for anti-HEV IgG, consequently, 704 patients were included in the study. Six-hundred and twenty-one (88.2%) complete the study period. The median follow-up (interquartile range) was 11.96 months (8.52-14.52). Thirty-four (5.4%) patients seroconverted for anti-HEV IgG during the follow-up. This represent an incidence rate of 5.6 cases /100 patients-year (95% CI: 3.8%-7.5%). Among the 34 HEV seroconverted patients, in two (5.8%) HEV-RNA was amplified. Twenty-one patients (61.7%) presented clinical manifestation and/or changes in liver function test at the time of seroconversion. The more frequent clinical manifestations were: fever (11/21; 52.3%), digestive manifestation (12/21; 57.1%), diffuse abdominal pain (10/21; 47.6%) and asthenia (20/21; 95.2%). Among these patients, one (co-infected with Hepatitis B virus in liver cirrhosis stage) presented liver decompensation (ascites) at the moment of the HEV seroconversion. Interestingly, 10 (47.6%) of these patients experienced HIV viral blips during the HEV seroconversion. Conclusions: HEV present a high prevalence and incidence in HIV infected patients. In the majority of patients, HEV infection curse as a symptomatic disease. In our study, HEV seroconversion was associated with HIV viral blips.

TUESDAY, FEBRUARY 24, 2015 Session P-O1 Poster Session

Poster Hall

2:30 pm– 4:00 pm HPV Infections and Cancers

710 Factors AssociatedWith Extensive Cervical Lesions Among HIV-InfectedWomen Screening for AIDS Clinical Trials Group (ACTG) Protocol A5282 Timothy J. Wilkin 1 ; Roy Matining 2 ;Vikrant Sahasrabuddhe 3 ; Catherine Godfrey 4 ;Thandie Lungu 5 ; Mulindi Mwanahamuntu 6 ; Ramesh Bhosale 7 ; Scott Evans 2 ; RobertW. Coombs 8 ; Cynthia Firnhaber 9 1 Weill Cornell Medical College, New York, NY, US; 2 Harvard School of Public Health, Center for Biostatistics in AIDS Research, Cambridge, MA, US; 3 National Cancer Institute (NCI), Bethesda, MD, US; 4 Division of AIDS (DAIDS), NIAID, NIH, Bethesda, MD, US; 5 University of North Carolina Project–Malawi, Lilongwe, Malawi; 6 University Teaching Hospital, Lusaka, Zambia; 7 Byramjee Jeejeebhoy Medical College, Pune, India; 8 University of Washington, Seattle, WA, US; 9 University of Witswatersand, Johannesburg, South Africa Background: ‘Screen-and-treat’ approaches for prevention of cervical cancer are used in many resource-constrained settings because of the challenges associated with cytology. Women are screened with: (1) visual inspection after acetic acid (VIA), or (2) testing for high-risk human papillomavirus (hrHPV), followed by treatment with cervical cryotherapy for those screening positive. However, women may have extensive cryotherapy-ineligible lesions that require excisional procedures. We explored factors associated with these lesions to inform broad implementation of screen and treat programs. Methods: Cross-sectional study of HIV-infected women screening for A5282, a randomized clinical trial comparing the HPV screen and treat approach to a cytology-based strategy for prevention of cervical cancer. Participants were screened with colposcopy (visual inspection after acetic acid wash using magnification without biopsy), HPV testing (Abbott® hrHPV PCR assay), and cytology. Colposcopy results were categorized as no lesions, cryo-eligible lesions, and cryo-ineligible lesions according to WHO criteria. Participating sites included 8 in sub-Saharan Africa, 2 in India, 1 in Haiti, and 1 in Peru. Fisher’s exact test was used to test for association. Results: 907 women who screened for A5282 had complete colposcopy, hrHPV, and cytology results. The median age (years) was 37 [IQR 32, 42]; median CD4 (cells/mm 3 ) was 524 [IQR 386, 712]; 70% has plasma HIV-1 RNA <40 copies/mL. Cryo-ineligible lesions were not associated with CD4 count or plasma HIV-1 RNA. The prevalence of cryo-ineligible lesions was significantly higher in women with hrHPV than without (105/403, 26% vs. 44/504, 9%, P <0.001), and in those with abnormal cytology than with normal cytology (110/597, 18% vs. 39/310, 13%, P =0.024).

Poster Abstracts

Conclusions: Extensive cervical lesions that are not eligible for treatment with cryotherapy are relatively common (~1 in 6) among HIV-infected women and are not associated with immune suppression or lack of virological control. Adequate treatment for these lesions, such as loop electrosurgical excision procedure, should be readily available within ‘screen-and-treat’ implementation programs. Further studies are needed to define the optimal management of these lesions. 711 HIV Infection and Survival AmongWomenWith Cervical Cancer in Botswana Scott Dryden-Peterson 1 ; Memory Bvochora-Nsingo 2 ; Heluf Medhin 3 ; Gita Suneja 4 ; Aida Asmelash 5 ; Malebogo Pusoentsi 3 ; Anthony Russell 6 ; Jason Efstathiou 6 ; Bruce Chabner 6 ; Shahin Lockman 1 1 Brigham and Women’s Hospital, Harvard Medical School, Jamaica Plain, MA, US; 2 Gaborone Private Hospital, Gaborone, Botswana; 3 Botswana Ministry of Health, Gaborone, Botswana; 4 University of Utah, Salt Lake City, UT, US; 5 Botswana Harvard AIDS Institute, Gaborone, Botswana; 6 Massachusetts General Hospital, Harvard Medical School, Boston, MA, US Background: Cervical cancer is the most common malignancy in African women and incidence has increased with expansion of ART coverage. We sought to prospectively evaluate the association between HIV-infection and survival of patients diagnosed with cervical cancer in a country with high HIV treatment coverage. Methods: We enrolled sequential patients presenting for initial treatment of cervical cancer at two referral hospitals in Gaborone, Botswana from October 2010 through September 2014. Consenting patients were tested for HIV and their records were abstracted. Standard treatment included radiation (both external beam and brachytherapy) with concurrent cisplatin added for locally advanced cases. Patients were followed every 3 months for treatment outcome. Association between HIV infection and all-cause mortality was assessed using the logrank test and Cox proportional hazards modeling. Results: A total of 215 women with cervical cancer were enrolled, including 146 (67.9%) HIV-infected, 58 (27.0%) HIV-uninfected, and 11 (5.1%) with unknown HIV status. Only 8 (3.7%) cancers were identified by screening and symptoms prompted diagnosis in remaining 207 (96.3%). HIV-infected women were younger than women without HIV—median age 41.3 and 57.6 years, respectively (P<0.001). At presentation with cancer, the median CD4 count for HIV-infected women was 406 cells/ μ L (IQR 283 - 550 cells/ μ L) and 86.8% were receiving ART (median duration 4.4 years). Sixty-eight (47.9%) of HIV-infected women and 22 (39.3%) of HIV-uninfected women presented with FIGO stage 3 or 4 cancer

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CROI 2015