CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

865 Maternal Viral Load in the Context of PMTCT B+Within the Kabeho Study in Kigali Emily A. Bobrow 1 ; Placidie Mugwaneza 2 ; Gilles F. Ndayisaba 3 ; Dieudonne Ndatimana 3 ; Michelle Gill 1 ; Heather J. Hoffman 4 ; Cyprien Baribwira 5 ; Laura Guay 1 ; Anita Asiimwe 6 Kabeho StudyTeam 1 Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, US; 2 Ministry of Health, Kigali, Rwanda; 3 Elizabeth Glaser Pediatric AIDS Foundation, Kigali, Rwanda; 4 George Washington University Milken Institute School of Public Health, Washington, DC, US; 5 University of Maryland, School of Medicine, Kigali, Rwanda; 6 Rwanda University Teaching Hospitals, Kigali, Rwanda Background: In April 2012, Rwanda started to implement a policy to initiate HIV-positive pregnant women on lifelong antiretroviral treatment (ART) (‘Option B+’). In April 2013, EGPAF and the Ministry of Health began the Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) Study. The study will determine 18 and 24 month HIV-free survival of a cohort of HIV-exposed children in the PMTCT program. Methods: From April 2013-January 2014, 608 HIV-positive women on triple drug ART in the third trimester of pregnancy or within two weeks post-delivery were enrolled in the observational prospective cohort from 14 health facilities in Kigali. After providing written informed consent, women underwent enrollment, including HIV and ART-related history and adherence, and a blood draw for viral load (VL) testing by RNA-PCR (Roche). Results: The median time women knew their HIV-positive status was 38.0 months (IQR 4.7–83.5). The most common ARV regimen (56.6%, 344/608) was TDF/3TC/EFV. Overall, 35.2% (n=214) of women reported taking another regimen previously; 21.5% (n=130) due to PMTCT during an earlier pregnancy. At enrollment, women were on ART for a median of 13.4 months (IQR 2.96–48.8); median time on current ART was 9.2 months (IQR 2.3-34.8). The adherence rate based on a 3-day ART recall was 90.9%. Side effects were reported in the past month by 17.5% (n=105) of women, with dizziness as most common (n=53). Half of women (52.2%, 316/606) had undetectable VL. Figure 1 shows the distribution of VL by ART duration. Logistic regression using GEE (N=579) indicates women were more likely to have a detectable VL if they had no education (AOR=2.21, 95% CI: 1.31, 3.73), reported side effects in the past month (AOR=1.96, 95% CI: 1.37, 2.81), and had been on ART less than four months, when compared to those with ART exposure from 4-12 months (AOR=3.98, 95% CI: 2.11, 7.50), 12-24 months (AOR=6.04, 95% CI: 2.47, 14.76), and 24-36 months (AOR=5.57, 95% CI: 2.38, 13.05). VL slightly decreased beyond 36 months on ART (AOR=3.56, 95% CI: 1.69, 7.50).

Oral Abstracts

Figure 1. Distribution of viral loads stratified by time on ART. Conclusions: High rates of ART adherence in the antenatal/peripartum period under Option B+ were reported. However, only half of women had undetectable VL at enrollment. Findings suggest longer ART duration may be needed for women in PMTCT to achieve viral suppression. Testing for ARV resistance is planned. Analysis of the cohort will incorporate specific regimen information, regimen changes, longitudinal VL, and adherence over time. 866 ART Response Among Pregnant and PostpartumWomenWith Acute Versus Chronic HIV-1 Alison L. Drake 1 ; John Kinuthia 2 ; Daniel Matemo 2 ; Barbra Richardson 1 ; Michael Chung 1 ; James N. Kiarie 2 ; Sandy Emery 3 ; Julie M. Overbaugh 3 ; Grace John-Stewart 1 1 University of Washington, Seattle, WA, US; 2 University of Nairobi, Nairobi, Kenya; 3 Fred Hutchinson Cancer Research Center, Seattle, WA, US Background: Risk of mother-to-child HIV-1 transmission (MTCT) is high among women with acute HIV-1 infection (AHI). Plasma HIV-1 viral load (PVL) can be substantially reduced with antiretroviral therapy (ART), which reduces MTCT risk; however, viral decline post-ART among pregnant and postpartumwomen with AHI has not been well characterized. We compared virologic and immunologic responses to ART between pregnant and postpartumwomen with AHI versus chronic HIV-1 infection (CHI) in Kenya. Methods: Women with AHI (detected by nucleic acid amplification tests conducted serially during pregnancy and postpartum) initiating ART (3TC, EFV, and either ZDV or TDF) were identified in a prospective study in Western Kenya. Women with CHI who initiated ART (AZT, 3TC, and NVP) during pregnancy in a prior clinical trial in Nairobi and had available PVL and CD4 data were selected for comparison. Blood was collected serially in both studies to compare post-ART changes in PVL and CD4; PVL was evaluated using the same laboratory and assay for both studies. Linear mixed effects models were used to model rate of PVL decline and demographics and CD4 were compared by the Wilcoxon Rank-Sum Test. Results: Data from 25 women with AHI and 30 women with CHI were compared. Women with AHI were younger (median 21 vs. 30 years; p=.006) and less likely to be married (97% vs. 76%; p=.02) than women with CHI. Mean baseline PVL was similar (AHI: 4.52, CHI: 4.37 log 10 copies/mL; p=.5). Baseline CD4 count was significantly higher in women with AHI than CHI (median 542 vs. 267, respectively; p<.001). Average monthly decline in PVL during 10 weeks post-ART was greater among women with CHI (-1.04 log 10 copies/mL; 95% Confidence Interval [CI]:-1.50,-0.57) than AHI (-.67 log 10 copies/mL, 95% CI:-0.84, -0.47); CHI versus AHI PVL decline p=.007), adjusting for baseline CD4. Viral decline was less pronounced 10 to 24 weeks post-ART in both groups, but remained steeper among women with CHI versus AHI (-.15 versus -.03 log 10 copies/mL, respectively; p=.002). Change in CD4 counts 6 months post-ART was similar (p=.5).

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CROI 2015