CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

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).

Poster Abstracts

Conclusions: Rate of viral decline following ART was significantly slower among women with AHI than CHI, perhaps because HIV-specific immune responses that work synergistically with ART to decrease PVL have not yet developed in AHI. Strategies to accelerate viral decline, such as ART-intensification among AHI during pregnancy and postpartum, may be useful to reduce MTCT risk.

TUESDAY, FEBRUARY 24, 2015 Session P-T2 Poster Session

Poster Hall

2:30 pm– 4:00 pm Rates and Risks of MTCT and HIV-Free Survival 867 No Perinatal Transmission of HIV-1 inWomen Efficiently Treated Since Conception Laurent Mandelbrot 1 ; RolandTubiana 2 ; Jérome Le Chenadec 3 ; Catherine Dollfus 4 ; Albert Faye 5 ; Christine Rouzioux 6 ; Anais Perilhou 3 ; JosianeWarszawski 7 ; Stéphane Blanche 6 The ANRS-EPF (CO1/CO10/CO11) Study Group

1 AP-HP, Hôpital Louis Mourier - INSERM U1018, CESP - Université Paris 7, Colombes, France; 2 AP-HP, Hôpital Pitié Salpêtrière - INSERM, U943, Paris, France; 3 INSERM CESP U1018, Le Kremlin-Bicetre, France; 4 AP-HP, Hôpital Trousseau, Paris, France; 5 AP-HP, Hôpital Robert Debre-University Paris 7, Paris, France; 6 AP-HP, Hôpital Necker-Enfants Malades, University Paris-Descartes, Paris, France; 7 University Paris-Sud - INSERM CESP U1018 - AP-HP Hopital Bicetre, Le Kremlin-Bicetre, France Background: The efficacy of prevention of perinatal transmission of HIV-1 is dependent on both viral load and treatment duration. The objective of this study was to determine whether initiating highly active antiretroviral treatment (HAART) before conception has the potential to eliminate perinatal transmission. Methods: In the national prospective multicentre French Perinatal Cohort (EPF), perinatal transmission (PT) was analysed according to the viral load (VL) in maternal plasma near delivery and timing of HAART initiation in 7937 HIV-infected women from 2000 to 2011.

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CROI 2015