O14.6 Aetiology of Infectious Proctitis Differs by HIV Status

Abstract

Methods We undertook a study of MSM who presented to Melbourne Sexual Health Centre with symptomatic proctitis between March 2003 and December 2011. Men with proctitis were tested for gonorrhoea by culture, chlamydia by strand displacement assay, and herpes simplex virus (HSV) by PCR. Chlamydia positive specimens were genotyped for lymphogranuloma venereum (LGV). Results Among the 279 men in the study, 141 were HIV positive and 138 were HIV negative. The median CD4 count among HIV positive men was 423 (range 189-1026). The prevalence of infections among HIV positive and HIV negative men respectively was: chlamydia (23.4% versus 21.7%, p = 0.7); gonorrhoea (13.4% versus 10.8%, p = 0.5); HSV-1 (14.2% versus 6.5%, p = 0.04); HSV-2 (22% versus 12.3%, p = 0.03); and LGV (7.8% versus 0.7%, p = 0.004). HIV positive men were more likely to have multiple infections (17.7% versus 8.6%, p = 0.017). Only 32% of men with HSV associated proctitis had visible anal ulceration. Conclusion Among MSM presenting with proctitis, HSV, LGV and multiple infections are more common among HIV positive men than among HIV negative men. MSM presenting with proctitis require comprehensive testing and treatment for possible pathogens including herpes in the absence of anal ulceration. Background Despite receipt of combination antiretroviral therapy (cART) and subsequent viral suppression some 15-30% of treated HIV infected patients fail to achieve optimal CD4 T-cell reconstitution. Sub-optimal CD4 recovery has been associated with unfavourable outcomes for patients on cART. We assessed markers of immune activation, microbial translocation and patient baseline characteristics for associations with sub-optimal CD4 T-cell recovery post cART initiation. Methods This was a retrospective case control analysis of CD4 T-cell recovery from a completed (2002)(2003)(2004)(2005)(2006)(2007) clinical trial, the Adult Antiretroviral Treatment and Drug Resistance ("Tshepo") Trial, in Gaborone, Botswana. Cases (sub-optimal CD4 response) were defined as CD4 ≤ 200 cells/µl at 12 months post ART initiation, with virologic suppression achieved within 6 months. Microbial translocation (sCD14) and immune activation (interferon-gamma) markers were quantified using Enzyme Linked Immuno-Sorbent Assays on a subset of 30 cases and 30 controls gender matched baseline and 12 month plasma samples. Univariate and logistic regression analysis were used to assess predictors of suboptimal CD4 T-cell recovery. Results Fifty-one cases (21%) from 249 virologically suppressed patients had sub-optimal CD4 recovery. The median age was 33.39 years and 69.9% were female. Baseline CD4 count < 100cells, haemoglobin and aspartate transaminase were associated with suboptimal CD4 recovery (adjusted OR (aOR) = 3.03 95% CI [1. 65, 5.57], p < 0.001; aOR = 0.81 [0.67, 0.99], p = 0.038 and aOR = 1.03 [1.00, 1.05], respectively). sCD14 levels were significantly different between cases and controls, p = 0.0011, at 12 months. Baseline Tuberculosis infection, body-mass-index, interferon-gamma, ala...

Summary and highlights of the scientific tracks at the STI & AIDS World Congress 2013, Vienna

“…CT was more common than GC as a cause of proctitis, but both were common in both HIV-positive and HIV-negative men. 17 HSV (36% versus 19%) and LGV (7.8% versus 0.7%) were significantly more common in HIV positive men than HIV negative men. 17…”

“…16 At the University of Melbourne, Bissessor et al. 17 (O14.6) investigated the causes of infectious proctitis in HIV-positive and HIV-negative men. CT was more common than GC as a cause of proctitis, but both were common in both HIV-positive and HIV-negative men.…”