CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: While VIA had lower sensitivity (62.7%), its low cost ($2.05) projected it to have the lowest lifetime cost while producing the highest health gains. HPV testing was the most sensitive test (83.6%); however, its relatively high cost ($10.34) made VIA a better choice. Low risk treatment and high cervical cancer cost caused screening cost to drive the model. Screening women with high CD4 is particularly cost-effective because longer life expectancy leads to higher health gains with less cost variation. Costing and time motion studies are currently being undertaken in Kenya to more accurately represent costs for improved analysis and results. 713 Anal High-Risk Human Papillomavirus (HPV) Infection Among HIV-Infected MSM in the SUN Study, 2004-2011 Pragna Patel 1 ;Tim Bush 1 ; Erna Kojic 2 ; Lois Conley 1 ; Elizabeth Unger 1 ;Teresa Darragh 3 ; Keith Henry 4 ; John Hammer 5 ; Nur Onen 6 ; Joel Palefsky 3 1 CDC, Atlanta, GA, US; 2 Brown University, Providence, RI, US; 3 University of California San Francisco, San Francisco, CA, US; 4 University of Minnesota, Minneapolis, MN, US; 5 Denver Infectious Diseases Consultants, Denver, CO, US; 6 Washington University School of Medicine, St. Louis, MO, US Background: Incidence and clearance of anal high-risk HPV (HR-HPV) infection in HIV-infected men who have sex with men (MSM) have not been well characterized. These dynamics may have implications for vaccine strategies to reduce anal cancer burden. Methods: The SUN Study is a prospective observational cohort of HIV-infected patients receiving care in four U.S. cities. Among MSM, we evaluated the baseline prevalence of HPV types 16 and 18 at the anus and incidence and clearance annually over 48 months using Kaplan-Meier survival analysis. For men with prevalent HPV 16 or HPV 18, we defined clearance as two consecutive visits where the respective HPV type was undetected. We assessed the associations of prevalent and incident infection, and clearance of prevalent infection, with selected baseline behavioral and clinical characteristics. Results: In 403 MSM, the median age was 42 years; 78%were prescribed HAART; median CD4 cell count was 454 cells/mm 3 ; and 74% had an undetectable viral load. The prevalence of HPV 16 was 38% (n=152) and HPV 18 was 24% (n=97) (p=0.193); 10% (n=42) were co-infected with both HPV types. Men who injected drugs were more likely to be infected with prevalent HPV 16 (53% vs. 36%, p=0.024), while men with rectal Neisseria gonorrhea infection (67% vs. 24%, p=0.009), CD4 cell count < 500 cells/mm 3 (29% vs. 17%, p=0.004), and ≥ 4 sex partners during the 6 months before baseline (33% vs. 21%, p=0.012) were more likely to be infected with prevalent HPV 18. Over 48 months, the incidence of HPV 16 was 23% (95% confidence interval (CI): 18%-30%) and of HPV 18 was 13% (95% CI: 9%-17%). Five percent (n=8) had both incident HPV 16 and 18 detected. Anal sex in the 6 months before baseline (31% vs. 14%, P=0.006) and consuming alcohol in 30 days before baseline (25% vs. 10%, p=0.038) were associated with HPV 16; marijuana use in 6 months before baseline was associated with HPV 18 (20% vs. 10%, p=0.021). At 48 months, 26% (95% CI: 18%-36%) cleared prevalent HPV 16 and 50% (95% CI: 38%-64%) cleared HPV 18 (Figure). In MSM with vs without persistent HPV 16 and 18, squamous intraepithelial lesions were detected in 56% vs 37% (p=0.006), and 68% vs 38% (p=0.003), respectively. MSMwho reported ever using methamphetamine vs no use were less likely to clear HPV 16 (24% vs 46%, p=0.039).

Poster Abstracts

Conclusions: Among HIV-infected MSM with a prevalent HR-HPV infection, 26%with HPV 16 and 50%with HPV 18 cleared by 48 months. MSM using methamphetamine vs no use may be at higher risk for anal dysplasia and cancer. 714 Long-Term Effectiveness of Electrocautery Ablation of HGAIN in HIV-Infected MSM Joaquin Burgos 1 ; Adria Curran 1 ; NataliaTallada 1 ; Ana Guelar 2 ; Jordi Navarro 1 ; Stefania Landolfi 1 ; JudithVillar 2 ; Manel Crespo 1 ; Esteve Ribera 1 ;Vicenç Falco 1 1 University Hospital Vall d’Hebron, Barcelona, Spain; 2 University Hospital del Mar, Barcelona, Spain Background: HIV-infected men who have sex with men (MSM) are at risk for high-grade anal intraepithelial neoplasia (HGAIN) and anal cancer. The goal of the anal screening programs is to identify these precancerous lesions in order to ablating them and hence reducing the incidence of anal cancer. Although electrocautery (EC) is one of the main treatment options, there are scarce data regarding its efficacy. The aim of the study was to evaluate the effectiveness of EC for the treatment of HGAIN. Methods: Observational study of HIV-infected MSM diagnosed with HGAIN in our screening program treated with EC ablation. The effectiveness of treatment was evaluated for each cycle (including 3-5 electrocautery sessions) and at the end of the full (including all cycles for each patient). Response was evaluated according to anal biopsy samples obtained 2-3 months after treatment. Complete response was defined as resolution of HGAIN and partial response as regression to low-grade AIN. Recurrence was considerate as biopsy-proven HGAIN in the follow-up after the treatment. The effectiveness was evaluated using an on-treatment analysis. Patients who interrupted treatments or were lost to follow-up were censured. Results: FromMay 2009 to September 2014, 111 (19.7%) patients out of 564 who underwent anal cancer screening had HGAIN. The treatment effectiveness was evaluated in 73 patients. A complete response was observed in 21 (28.8%; 95% CI, 19.6-40), a partial response in 26 (35.6%; 95% CI, 25.6-47.1) and persistence in 26 (35.6%; 95% CI, 25.6-47.1). In 85% of the patients treated successfully, only one cycle of EC was required. The effectiveness of the 96 evaluable cycles of treatment was: 22% complete response, 27% partial response and 51% non response. No patients developed serious adverse events after EC. No differences regarding HIV infection, sexual behavior or anal dysplasia characteristics were observed between responders and no responders. After a mean follow-up of 18.3 months, 10 of 47 patients (21.3%; 95% CI, 12-35) with a complete or partial response developed recurrent HGAIN with a mean time to recurrence of 39 (95% CI, 30.7-47.3) months. No patient progressed to invasive anal cancer during the study period.

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CROI 2015