Thomas O'bryan

A Single Dose of Benzathine Penicillin G Is as Effective as Multiple Doses of Benzathine Penicillin G for the Treatment of HIV-Infected Persons With Early Syphilis

BACKGROUND Treatment guidelines recommend the use of a single dose of benzathine penicillin G (BPG) for treating early syphilis in human immunodeficiency virus (HIV)-infected persons. However, data supporting this recommendation are limited. We examined the efficacy of single-dose BPG in the US Military HIV Natural History Study. METHODS Subjects were included if they met serologic criteria for syphilis (ie, a positive nontreponemal test [NTr] confirmed by treponemal testing). Response to treatment was assessed at 13 months and was defined by a ≥4-fold decline in NTr titer. Multivariate Cox proportional hazard regression models were utilized to examine factors associated with treatment response. RESULTS Three hundred fifty subjects (99% male) contributed 478 cases. Three hundred ninety-three cases were treated exclusively with BPG (141 with 1 dose of BPG). Treatment response was the same among those receiving 1 or >1 dose of BPG (92%). In a multivariate analysis, older age (hazard ratio [HR], 0.82 per 10-year increase; 95% confidence interval [CI], .73-.93) was associated with delayed response to treatment. Higher pretreatment titers (reference NTr titer <1:64; HR, 1.94 [95% CI, 1.58-2.39]) and CD4 counts (HR, 1.07 for every 100-cell increase [95% CI, 1.01-1.12]) were associated with a faster response to treatment. Response was not affected by the number of BPG doses received (reference, 1 dose of BPG; HR, 1.11 [95% CI, .89-1.4]). CONCLUSIONS In this cohort, additional BPG doses did not affect treatment response. Our data support the current recommendations for the use of a single dose of BPG to treat HIV-infected persons with early syphilis.

HIV viraemia during hepatitis B vaccination shortens the duration of protective antibody levels

Individuals with HIV infection often have early waning of protective antibody following hepatitis B virus (HBV) vaccination. HIV viraemia at the time of vaccination may limit the durability of serum anti‐HBV surface antibody (HBsAb) levels. We investigated the relationship of HIV plasma viral load (VL) and duration of HBsAb among vaccinees enrolled in the US Military HIV Natural History Study.

Brief Report: Racial Comparison of D-dimer Levels in Us Male Military Personnel Before and After Hiv Infection and Viral Suppression

Background: D-dimer blood levels in persons with HIV infection are associated with risk of serious non-AIDS conditions and death. Black race has been correlated with higher D-dimer levels in several studies. We examined the effects of race and HIV on D-dimer over time and the impact of viral load suppression by longitudinally comparing changes in levels among healthy young adult male African Americans and whites before HIV seroconversion and before and after initiation of antiretroviral therapy (ART). Methods: We analyzed D-dimer levels and clinical and laboratory data of 192 participants enrolled in the US Military HIV Natural History Study, a 30-year cohort of military personnel infected with HIV. D-dimer levels were measured on stored sera from each participant at 3 time points: (1) before HIV seroconversion (Pre-SC), (2) ≥6 months after HIV seroconversion but before ART initiation (Post-SC), and (3) ≥6 months after ART with documented viral suppression (Post-ART). Levels were compared at each time point using nonparametric and logistic regression analysis. Results: Compared with whites (n = 106), African Americans (n = 86) had higher D-dimer levels post-SC (P = 0.007), but in the same individuals, pre-SC baseline and post-ART levels were similar (P = 0.40 and P = 0.99, respectively). There were no racial differences in CD4 cell counts, HIV RNA viral load, time from estimated seroconversion to ART initiation, and duration on ART. Conclusions: Observed longitudinally, racial differences in D-dimer levels were seen only during HIV viremia. Higher levels of D-dimer commonly observed in African Americans are likely due to factors in addition to race.

1561The Relationship Between Self-reported Adherence and Efavirenz Blood Levels on the Appearance of HIV Viral Load Blips

www.PosterPresentations.com The Relationship Between Self-reported Adherence and Efavirenz Blood Levels on the Appearance of HIV Viral Load “Blips” Aaron Farmer1, Thomas O’Bryan1,2, Anuradha Ganesan2,3, Robert G Deiss2,4, Brian Agan2, Kevin S. Akers1,5, Jason Okulicz1,2 1Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX. 2Infectious Disease Clinical Research Program, Uniformed Service University, Bethesda, MD. 3Walter Reed National Military Medical Center, Bethesda, MD. 4Naval Medical Center, San Diego, CA. 5-US Army Institute of Surgical Research, Fort Sam Houston, TX

1566Factors Associated with 10 Years of Continuous HIV Viral Load Suppression on HAART

Suppression on HAART Kathryn Bello, DO; Octavio Mesner, MS; Thomas O’bryan, MD; Tahaniyat Lalani, MBBS, MHS; Anuradha Ganesan, MD; Brian Agan, MD; Jason Okulicz, MD; Internal Medicine, San Antonio Military Medical Center, Fort Sam Houston, TX; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; Naval Medical Center Portsmouth, Portsmouth, VA; Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX