Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

TUPEO286
Sexually transmitted infection (STI) surveillance
linked with HIV sentinel sero-surveillance,
5 Vietnamese provinces
H. Pham', H. Nguyen1, P. Pham', K. Trans, C. Luu2, P. Le3, T. Trinh4, M. Kambs,
L. Cosimis, M. Wolfe4. 1Vietnam National Institute of Dermato- Venereology,
Hanoi, Viet Nam, 2Viet Nam Ministry of Health (MOH)-LIFE/GAP Office, Hanoi,
Viet Nam, 3HaNoi Medical University (HMU), Hanoi, Viet Nam, 4Center for
Disease Control and Prevention (CDC)/Global AIDS Program (GAP)Viet Nam,
Hanoi, Viet Nam, 'Center for Disease Control and Prevention (CDC)/Global
AIDS Program (GAP)Viet Nam, Atlanta, United States

TUPEO288
High prevalence of HIV-RNA excretion from the
genital ulcers of co-infected STD patients in
Lilongwe, Malawi
S. Phiri', I. Hoffman2, N. Nyirenda3, D. Maccormick3, S. Fiscus2, C. Chen4,
H. Weiss5, W. Miller2, G. Joaki3, D. Chilongozi', F. Martinson3,
L. van der Hoeven6, M. Cohen2, P. Mayauds. 'Lighthouse at Kamuzu Central
Hospital, Lilongwe, Malawi, 2UNC, Chapel Hill, NC, United States, sUNC,
Lilongwe, Malawi, 4CDC, Atlanta, United States, sLondon School of Hygiene
and Tropical Medicine, London, United Kingdom, 'Reproductive Health Unit,
Ministry of Health, Lilongwe, Malawi

Background: We soug
existing annual HIV sent
prevalence among popul
Methods: In 2003, we
about their willingness
for STI testing. Participa
syndromic guidelines. Ur
(CT) and N. gonorrhoe
pregnant women and FS
(TV) and C. albicans (CA
Results: A total of 6898
STD clinic attenders, 99
groups); and 2000 milit
(low risk groups). STI a
Risk groups HIV
Military 0.8
recruits
Antenatal 0.3
women
Male STD
clinic 4.0
attenders
IDUs 38.7

ht to assess feasibility of linking STI surveillance to Background: Pathogens causing genital ulcer disease (GUD) have been
inel sero-surveillance (HIV SS) in order to estimate STI strongly associated with HIV acquisition, but there is much less evidence of
ations at low and high risk for HIV. their direct role in HIV transmission. Demonstration of detection of HIV RNA
asked volunteers in annual HIV SS in 5 provinces associated with particular GUD etiologies would support their role in HIV
to provide urine and wet mount (women) specimens transmission.
nts reporting STI symptoms were treated per national Methods: A randomised placebo-controlled trial evaluating the impact of the
ine specimens were tested using PCR for C.trachomatis addition of acyclovir as episodic treatment for HSV-2 on ulcer healing and
ae (NG), serum for RPR/TPHA and HIV testing. For HIV-1 genital shedding is underway in Lilongwe, Malawi. GUD patients are
Ws, wet mount preparations were done for T. vaginalis interviewed, examined and samples collected prior to randomization. Ulcer
). swabs are assessed for GUD etiologies (T. pallidum, H. ducreyi, HSV and LGV)
3 persons were tested for STI; these included 950 male by real-time multiplex PCR, and for HIV-1 RNA using the Roche 1.5 assay. Blood
8 male IDUs, 950 female sex workers (FSWs) (high risk is tested for syphilis, HIV, and HSV-2 (HerpeSelect, Focus) serologies.
ary recruits (ages 18-20) and 2000 antenatal women Results: By Nov 2005, 250 patients (204 men, 46 women) had been enrolled,
nd HIV results are shown in the table of whom 150 (60%) were HIV-1 sero-positive and 175/236 (74%) were HSV2 sero-positive. Presence of lesional HIV-1 RNA was detected among 64%
Syphilis NG CT TV CA (82/128) HIV-1 sero-positive patients and 63% (72/114) HSV-2 sero-positive
Syphils. MG.C TV.patients. Among the 108 patients with both etiology and lesional HIV results,
0.2 1.4 4.2 NA NA 66 (61%) had detectable HSV and 63 (58%) had detectable HIV-1 RNA. There
was no increased frequency of lesional HIV-1 RNA among patients with HSV
0.4 1.0 3.7 0.1 11.0 ulcers versus other etiologies (37/63 [59%] vs 29/45 [640/%], p> 0.5).
Conclusions: HIV shedding from genital ulcers was frequently detected among
HIV-positive patients in Malawi and suggests the feasibility of enhanced HIV
2.2 3.5 2.1 NA NA transmission. There was no evidence of increased HIV detection among HSV2 infected patients prior to acyclovir treatment. Impact of this treatment on
1.0 0.8 1.3 NA NA ulcer healing rates and lesional HIV shedding will be assessed at the end of
the trial.

FSWs 6.7 2.9 2.9 4.3 4.3 4.6
Conclusions: STI surveillance linked with annual HIV sentinel surveillance was
feasible. STI rates tended to be low in all risk groups; although CT was higher
than expected in lower risk groups (antenatal women and military recruits).
High HIV rates in IDU are already well recognized, and HIV prevention in IDU
is already a national priority. However, these data suggest STI prevention
programs for FSW and HIV prevention efforts for STI-infected men are also
warranted.
TUPEO287
STI prevalence among adolescent
methamphetamine smokers requires new HIV/AIDS
prevention strategies
D. Celentano', B. Sirirojn2, S. Sherman', N. Thomson3, K. Wongworapat2,
L. Sintupat2, C. Sutcliffe', R. Kaewvichit2, K. Rungruengthanakit2, A.
Aramrattana2. 'Johns Hopkins Bloomberg School of Public Health,
Epidemiology, Baltimore, United States, 2Chiang Mai University, Research
Center for Health Sciences, Chiang Mai, Thailand, 'McFarlane-Burnet Institute,
Melbourne, Australia
Background: Sexually transmitted infections (STI) have been widely shown
to confer high risk for HIV acquisition. Drug use is associated with behavioral
risks for both STI and HIV. Southeast Asia is experiencing a methamphetamine
epidemic, with concerns that this will drive a new epidemic of STI among youth.
We analyzed recently collected data on current drug use and drug history,
sexual risk and history and prevalent STI in a cohort of young Thais.
Methods: Between May - October 2005, 247 youth (18-25 years) were
enrolled in a randomized behavioral intervention trial in Chiang Mai, Thailand;
the baseline assessment reported here included an interviewer-administered
structured assessment of drug and sexual histories, and standard laboratory
assays for common STIs. Logistic regression models to examine correlates of
any STI infection were constructed for the entire sample and by gender.
Results: Overall, 38% of the respondents had at least one laboratory confirmed
STI, more commonly in females (49.2%) than males (34.2%). Chlamydia was
the most prevalent (24.6%) STI found, followed by HSV-2 (14.5%), gonorrhea
(7.2%) and HIV (0.5%). No case of syphilis was found, and 9.3% and 3.8% were
found to have HBV and HCV, respectively. In multivariate analysis of the entire
sample, female gender and older age were associated with STI prevalence.
Among males, older age, frequent drunkenness, no condom use at last sex, and
usually having sex after using methamphetamine were independent significant
risks for prevalent STI. Among females, older age and number of casual and
lifetime partners were associated with higher STI prevalence.
Conclusions: STI among youthful methamphetamine users are common, and
are associated with lack of safer sex precautions. Interventions to prevent HIV
infection must address the intersection of both drug and sex risks if HIV is to
be contained.

TUPEO289
HIV and lymphogranuloma venereum (LGV)
co-infection in Canada
M.A. Gully, R.Y. Kropp, T. Wong. Public Health Agency of Canada, Community
Acquired Infections Division, Ottawa, Canada
Background: LGV increases the risk of acquiring or transmitting HIV, other
sexually transmitted infections (STIs), and blood-borne infections (BBIs). LGV
was rare in industrialized countries until recently; since January 2004, hundreds
of cases have been reported internationally (Europe, UK, US) in men having sex
with men (MSM). The objective of this analysis was to determine the proportion
of reported LGV cases in Canada that were co-infected with HIV and to examine
their sexual risk factors.
Methods: The Public Health Agency of Canada (PHAC) in partnership with the
provinces/territories established a national LGV surveillance system in February
2005. Cases reported to PHAC up to February 2006 were analysed, removing
missing information for each calculation; statistical analyses were carried out
using SAS version 8.
Results: Between February 2005 and February 2006, 44 LGV cases were
reported (26 confirmed, 18 probable); cases were male, mostly 30-50 years.
25/31(80.6%) of cases were co-infected with HIV. HIV co-infected cases were
also infected with: syphilis(29%), genital warts(36%), genital herpes(19%),
HBV(21%), HCV(15%), and gonorrhea(18%). 79% reported sex 60 days prior
to symptoms/clinic visit, all with male partners; 74% reported unprotected
sex during this time. Anal and oral contact were reported in 74% and 73%
respectively (unprotected 41% and 50% respectively). Other sexual behaviour
included: shared sex toys(23%), fisting(16%), rimming(10%), rectal
enema(19%), rectal crystal methamphetamine use(6%). Circumstances of
contact included: bathouse(41%), private residence(35%), internet(29%),
rave(9%), "leather scene"(5%). 17% reported sex while travelling (within
Canada, Mexico, Paris).
Conclusions: There is a high rate of HIV co-infection among LGV cases
in Canada; a large proportion are also co-infected with other STIs/BBIs.
Unprotected anal and oral contact was frequently reported as well as other
higher-risk sexual activities such as "fisting". Sexual contact in bathouses and
internet partnering were frequently reported. LGV can be prevented by condom
use and other barrier methods.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1