374. Lymphogranuloma Venereum (LGV) Outbreak Among People Living with HIV (PLWH): Michigan, 2015–2018

Abstract

BackgroundSexually transmitted infections (STIs) have increased in recent years both nationally and in Michigan. At the same time, HIV prevention is shifting toward intense efforts to “ending the epidemic.” Detecting and mitigating outbreaks, as well as monitoring co-infections in people living with HIV (PLWH), will be critical in these efforts. Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by a serovar of Chlamydia trachomatis and may present with proctitis, lymphadenopathy, or genital ulcers.MethodsWhile not nationally reportable, LGV remains on the list of reportable conditions in Michigan. No cases were reported between 2009 and 2014, but from August 12, 2015 to December 4, 2018, 68 cases of LGV were identified in 66 patients and reported by providers and laboratories through the Michigan Disease Surveillance System (MDSS). These reported cases were analyzed by specimen collection date and matched to other communicable disease databases for HIV co-infection status and STI history using SAS 9.4.ResultsThe outbreak was local to Southeast Michigan where all but three patients resided; 72% cases lived in Detroit (Figure 1). 94% of cases were co-infected with HIV, including 4 who were co-diagnosed within 30 days of LGV diagnosis. Among the 60 cases of PLWH (excluding co-diagnoses), 62% were virally suppressed (VS) and 32% were in care but not suppressed at the time of LGV diagnosis. The majority (88%) of outbreak patients had between 1 and 7 additional bacterial STIs in the two years prior to LGV. All reported cases were men who have sex with men (MSM) with two patients also reporting injection drug use (MSM/IDU).ConclusionTesting for LGV is not routine and in some settings not available so there are likely unreported cases missing from this outbreak analysis. HIV care outcomes differed from statewide estimates with outbreak patients more likely to be receiving care but not sufficiently engaged compared with all PLWH (Figure 2). A high proportion of cases with additional STI history combined with lower than average VS rate means transmission of HIV is likely. This highlights a need to integrate HIV care support with STI services. Additional analyses of HIV co-infection with syphilis or other STIs are needed to further inform these strategies. Disclosures All authors: No reported disclosures.