826. HIV Infection and HPV Genotype Patterns among Young Women with Advanced Cervical Neoplasia in Davidson County, Tennessee

Abstract Background Women living with HIV (WLWH) experience high rates of human papillomavirus (HPV) infection and increased risk of cervical cancer. High-risk HPV (HR-HPV) types 16/18 cause most cervical precancers and cancers in women with and without HIV. However, contributions of other HR-HPV types to cervical disease among WLWH are not fully understood. We compared CIN2+ cases (cervical intraepithelial neoplasia grade 2 or higher or adenocarcinoma in situ) and the association between non-16/18 HPV types among women with and without HIV. Methods Davidson County, Tennessee, women aged 18-39 years with CIN2+ diagnosed between 2008-2016 with HPV genotyping were included. HIV status, demographics, and histology were abstracted from medical records. Neighborhood-level socioeconomic factors were derived from Integrated Public Use Microdata Series. Archived cervical tissue was tested for 37 HPV types to define CIN2+ cases negative for HPV 16/18, regardless of presence of other HR-HPV strains. Characteristics of women with CIN2+ and HPV typing patterns were compared between women with and without HIV using Wilcoxon and Chi-square tests. Logistic regression assessed the association of non-16/18 HPV types and HIV infection, adjusting for age, race, calendar year, insurance, HPV vaccination, and neighborhood socioeconomic factors (selected a priori). Results Among 2,116 women included, 1,093 (52%) had neither HPV16 nor HPV18. Compared to women without HIV, the 27 WLWH included were more likely to be >30 years of age, Black race, and live in neighborhoods with higher measures of poverty (Table 1). HPV types did not statistically differ by HIV status, though WLWH had a higher number of HR-HPV types present (Table 2). HIV infection was not significantly associated with non-16/18 HPV type after adjusting for confounders (adjusted OR 0.86 [95%CI: 0.4-1.88]). Conclusion Among women with CIN2+, HIV infection was not significantly associated with non-16/18 HPV types. However, WLWH had a higher number of high-risk HPV types detected. Our study was limited by the small number of WLWH included. Disclosures All Authors: No reported disclosures

Background. Epidemiologic data from HIV/AIDS registries and inflammatory bowel disease (IBD) centers have identified comorbid IBD to be a challenge in the long-term care of patients with HIV, but data on management are sparse. At a multisite tertiary center, we examined medical management, disease control, and complications of patients with comorbid HIV and IBD.
Methods. We reviewed 126 charts between April 2017 and December 2020 for subjects 18+ years with HIV-1 infection and Crohn's disease (CD) or ulcerative colitis (UC). Participants received HIV and/or IBD care at Jefferson. We documented CD4 count, HIV viral load, IBD regimen, and the Harvey-Bradshaw Index (HBI) for CD and the Mayo Score for UC (DAI).
Results. Twelve patients met criteria for inclusion, n=6 with CD and n=6 with UC. They were all prescribed antiretroviral therapy (ART), with median CD4 722 and 83% virally suppressed (Table 1). 67% had ever been prescribed immunosuppressive IBD regimens while known to be HIV+. Eight patients had CD4s > 200 with low HBI or DAI. Patient #s 4, 8 and 10 were managed with only mesalamine. Patient #s 5 and 12 had received immunomodulators, with #5 controlled on azathioprine for years but stopped following admission for septic shock due to a thigh abscess, and #12 newly trialed methotrexate in the setting of IBD-related arthritis. Patient #s 2, 6, and 7 were treated with adalimumab: #2 newly for IBD-related arthritis, while #6 and #7 had been maintained long-term for luminal disease, but #7 was a new HIV diagnosis recently initiated on ART. Two patients were AIDS-defined with low HBI: #1 on mesalamine only, as infliximab was discontinued on HIV diagnosis with CD4 36, and #9 who was not on an IBD regimen. Two patients CD4 200+ had inconsistent viral suppression and moderate HBI/DAI: #3, who had responded to vedolizumab prescribed briefly during viral suppression but stopped due to poor follow-up and ART non-adherence, and #11, whose only documented IBD regimen since HIV diagnosis was chronic prednisone.

Table 1. Cohort Background and Currently Prescribed Regimens
These data observe the cohort's current regimens and longitudinal control. They do not include windows of prior medication trials that were not maintained, which are detailed in the text.
Conclusion. This small case series suggests that comorbid IBD and HIV patients may be managed successfully with immunosuppressive therapy when indicated. More information is needed regarding whether immunomodulators and biologics may affect CD4 and viral loads and conversely how poor control of HIV affects IBD activity.
Disclosures. Background. Women living with HIV (WLWH) experience high rates of human papillomavirus (HPV) infection and increased risk of cervical cancer. High-risk HPV (HR-HPV) types 16/18 cause most cervical precancers and cancers in women with and without HIV. However, contributions of other HR-HPV types to cervical disease among WLWH are not fully understood. We compared CIN2+ cases (cervical intraepithelial neoplasia grade 2 or higher or adenocarcinoma in situ) and the association between non-16/18 HPV types among women with and without HIV.
Methods. Davidson County, Tennessee, women aged 18-39 years with CIN2+ diagnosed between 2008-2016 with HPV genotyping were included. HIV status, demographics, and histology were abstracted from medical records. Neighborhoodlevel socioeconomic factors were derived from Integrated Public Use Microdata Series. Archived cervical tissue was tested for 37 HPV types to define CIN2+ cases negative for HPV 16/18, regardless of presence of other HR-HPV strains. Characteristics of women with CIN2+ and HPV typing patterns were compared between women with and without HIV using Wilcoxon and Chi-square tests. Logistic regression assessed the association of non-16/18 HPV types and HIV infection, adjusting for age, race, calendar year, insurance, HPV vaccination, and neighborhood socioeconomic factors (selected a priori).
Results. Among 2,116 women included, 1,093 (52%) had neither HPV16 nor HPV18. Compared to women without HIV, the 27 WLWH included were more likely to be >30 years of age, Black race, and live in neighborhoods with higher measures of poverty (Table 1). HPV types did not statistically differ by HIV status, though WLWH had a higher number of HR-HPV types present (