Durability of single tablet regimen for patients with HIV infection in Southern Taiwan: data from a real-world setting

Background A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real-world settings. Our aim was to investigate the durability of different initial STR regimens in antiretroviral-naive patients starting STR in southern Taiwan. Method This was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure. Secondary endpoints were STR discontinuation due to toxicity/intolerance. Durability was defined as time from the initiation until discontinuation/modification. Kaplan- Meier curves were plotted assessing time to virological suppression, treatment failure and discontinuation for the three STRs and Cox proportional hazards model was used to analyze the factors associated with time to viral suppression, treatment failure or discontinuation. Results Two hundred and twenty-three patients were included: The median follow-up duration (IQR) was 73.9 (48–101.6) weeks, 25 patients (11%) experienced virological failure; the 48 weeks probability of treatment failure was 22.9% (16/70) for Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate (EFV/FTC/TDF), 24.1% (13/54) for Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF) and 24.2% (24/99) for Abacavir/Dolutegravir/Lamivudine (ABC/DTG/3TC) (p=0.16). Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to EFV/FTC/TDF, treatment with FTC/RPV/TDF (aHR 8.39, CI 1.98–35.58, p = 0.004) and ABC/DTG/3TC (aHR 8.40, CI 2.39–29.54, p=0.001) were more likely to have treatment failure. The predictors for treatment failure included age ≦ 30 years old (aHR 3.73, CI 1.25–11.17, p = 0.018), switch between different STR (aHR 2.3, CI 1.18–4.50, p = 0.001) and free of active syphilis infection (aHR 0.24, CI 0.08–0.73, p = 0.012). The risk factor for treatment discontinuation included younger age ≦ 30 years old (aHR 3.82, CI 1.21–12.37, p = 0.023), treatment with EFV/FTC/TDF (aHR 8.65, CI 2.64–28.39, p < 0.001) and free of active syphilis infection (aHR 0.16, CI 0.04–0.62, p = 0.006). Conclusion Younger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. Treatment with ABC/DTG/3TC was associated with higher risk of treatment failure. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection.

1349. How Anchored is the Chancre? A Chart Review of Syphilis Treatment by a Safety Net Emergency Department in Atlanta, GA

Background Since reaching its nadir in 2000, syphilis has re-emerged as a public health threat in the U.S. The incidence of syphilis is disproportionately high in Atlanta, the epicenter of the HIV epidemic in the U.S. South. Given that syphilis infection is a strong predictor of HIV infection, identifying patients with syphilis is an important and underutilized method for connecting patients to HIV prevention and care services. Emergency departments (EDs) act as a critical access point to care in safety net health systems. We describe the recognition and empiric treatment of syphilis in the ED of Grady Healthcare System, a safety net hospital serving Atlanta. Methods We performed a retrospective chart review on all reactive rapid plasma reagin (RPR) tests collected from patients 18 years and older at the Grady ED from 5/1/20 to 10/31/20. We abstracted reported reason for testing, diagnosis, treatment administered, and location of treatment from the electronic health record. Results From 5/1/20 to 10/31/20, 148 patients with reactive RPR tests were identified. Reasons for testing were broad and included the evaluation of neurologic symptoms (47), genital/anal lesions (31), and a history of syphilis (18) (Table 1). 74 patients had presumed active syphilis (50%), 34 had previously treated syphilis (23%), 12 had false positives (8%), and 28 had an unclear diagnosis (19%) (Table 2). Of those with presumed primary syphilis who were discharged from the ED, 53% (8/15) received empiric treatment in the ED; 59% (10/17) of those with secondary syphilis received empiric treatment prior to discharge. Of the patients discharged from the ED, clinical follow up was indicated for 52% (31/59) given lack of empiric treatment or of confirmed prior treatment. Contact was attempted for 39% (12/31), but only 29% (9/31) were ultimately treated at Grady. Table 1: Abstracted Reasons for Testing for Syphilis in the ED For ED patients from 5/1/20-10/31/20 who had reactive RPRs, reasons for syphilis testing were taken from the chief complaint, history, or medical decision making documentation of ED providers, admitting providers, or consultants. Table 2: Syphilis Diagnoses of ED patients with reactive RPRs ED patients with a positive RPR from 5/1/20-10/31/20 were chart reviewed to determine their diagnosis. Previous RPR, treponemal antibodies, CSF results, media images, progress notes, and descriptions by medical staff were reviewed to attempt to retroactively determine the most likely syphilis diagnosis. Conclusion Reactive RPRs were common in this acute care setting and most represented active syphilis infection. Empiric treatment was most likely to be provided for patients with clear syphilis syndromes. However, a majority of patients who were discharged without empiric treatment did not receive follow up. Institutional protocols for following up reactive tests after discharge represent an opportunity to connect patients with syphilis treatment and HIV prevention services. Disclosures All Authors: No reported disclosures

High Incidence, Re-Infections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study

Background. Syphilis has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011-2015. Methods. Databases from the laboratory were analyzed and four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH) and patients from primary care clinics (others). Syphilis diagnosis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data was analyzed, and with follow-up information, a retrospective dynamic cohort was formed. Factors associated with seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. Results. A total of 81,863 baseline individuals were analyzed. Syphilis seroprevalence was 9.9% in VCT, 8.2% in PPr, 37.0% in PLWH, and 8.7% in others; the prevalence of active syphilis was 1.7-13.1%. A total of 11,124 people were followed-up; the incidence (cases per 100 years people) was 3.5 among VCT and 16.0 among PLWH; moreover, the frequency of re-infections was 11.1-24.4%. Men, transgender, persons between 20-39 years old, and individuals with a history of HIV or hepatitis B had a higher risk of syphilis. Conclusions. Several vulnerable groups have exhibited a reemergence of syphilis, with high prevalence of active syphilis, high incidence, and re-infections. Persons living with HIV had the highest risk.

High Incidence, Re-Infections, and Active Syphilis in Populations Attending A Specialized HIV Clinic in Mexico, A Dynamic Cohort Study.

Background. Syphilis has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011-2015.Methods. Databases from the laboratory were analyzed and four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH) and patients from primary care clinics (others). Syphilis diagnosis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data was analyzed, and with follow-up information, a retrospective dynamic cohort was formed. Factors associated with seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. Results. A total of 81,863 baseline individuals were analyzed. Syphilis seroprevalence was 9.9% in VCT, 8.2% in PPr, 37.0% in PLWH, and 8.7% in others; the prevalence of active syphilis was 1.7-13.1%. A total of 11,124 people were followed-up; the incidence (cases per 100 years people) was 3.5 among VCT and 16.0 among PLWH; moreover, the frequency of re-infections was 11.1-24.4%. Men, transgender, persons between 20-39 years old, and individuals with a history of HIV or hepatitis B had a higher risk of syphilis. Conclusions. Several vulnerable groups have exhibited a reemergence of syphilis, with high prevalence of active syphilis, high incidence, and re-infections. Persons living with HIV had the highest risk.

Using a dual antibody point-of-care test with visual and digital reads to diagnose syphilis among people living with HIV in Botswana

Syphilis data from low- and middle-income countries are lacking due to limited testing. Point-of-care tests (POCTs) have been promoted to expand testing but previously only included treponemal tests, which cannot distinguish active from past infection. We aimed to assess the feasibility of using a combined treponemal and non-treponemal POCT in HIV clinic patients in Gaborone, Botswana, and estimate syphilis prevalence in our clinic sample using this approach. We recruited 390 non-pregnant patients. Participants underwent a combined treponemal and non-treponemal POCT (Dual Path Platform (DPP®) Syphilis Screen and Confirm Assay (Chembio Diagnostic Systems)) on finger-prick blood sample and a questionnaire. Median age 45 years, 30% men, median CD4 count 565 cells/μL, and 91% had an HIV viral load <400 copies/mL. Five participants had active syphilis (1.3%, 95% CI 0.5–3.0%) and 64 had previous syphilis (16.4%, 95% CI 13.0–20.4%) using the DPP POCT. There was a reasonable level of agreement between digital and visual reading of the POCT (kappa statistic of 0.81); however, visual reading missed three active infections (60%). The level of active syphilis was similar to local antenatal data. The DPP POCT led to five participants with active syphilis being diagnosed and starting same-day treatment. The digital reader should be used.