CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

12 weeks before delivery, four of whom had detectable HIV RNA at delivery. For women receiving 3 ARVs, absence of viral suppression [aOR (6.7 95% CI 2.0, 22.1); p = 0.002] and < 4 weeks of ARVs before delivery [aOR 3.7(95% CI 1.1, 12.9); p= 0.04] were associated with a significantly higher risk of transmission.

Conclusions: Scale-up of universal triple-ARVs for all HIV-infected pregnant women in Botswana coincided with a fall in MTCT rates below 1%. Interventions to support earlier ART initiation and ensure virologic suppression could reduce MTCT even further. 871 Impact of Maternal Antiretroviral Regimen on Six-Month HIV-Free Survival in Botswana Rebecca Zash 1 ; Sajini Souda 2 ; Chazha Hick 3 ; Kelebogile Binda 3 ; Sikhulile Moyo 3 ; Erik vanWidenfeldt 3 ; Jean Leidner 4 ; Joseph Makhema 3 ; Mompati Mmalane 3 ; Roger Shapiro 1 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US; 2 University of Botswana, Gaborone, Botswana; 3 Botswana Harvard AIDS Institute, Gaborone, Botswana; 4 Harvard School of Public Health, Boston, MA, US Background: Tenofovir/Emtricitabine/Efavirenz (Atripla) is recommended by the World Health Organization for preventing mother to child HIV transmission (PMTCT). However, no studies have evaluated MTCT and HIV-free survival during the rollout period of an Atripla-based MTCT program. Methods: FromMarch 2012-March 2014, HIV+ women and their infants enrolled in 5 government-run post-natal wards in Botswana. During this time, national PMTCT program transitioned from Option A [Zidovudine (ZDV) for women with CD4 >250 and combination antiretroviral therapy (ART) for women with CD4 <250] to Option B (Atripla for all pregnant women regardless of CD4 count). Participants were interviewed every 1-3 months by phone or home visit to assess infant HIV status and mortality. Infants were tested for HIV by dried blood spot PCR at birth by the study, and at 6 weeks old as part of routine care (and after weaning i breast-fed). The association between PMTCT strategy and 6-month HIV-free survival was assessed by logistic regression modeling controlling for maternal time on ART, maternal age and CD4 count. Results: A total of 1499 women enrolled, representing 37% of all HIV+ women delivering during the study period. At delivery, 977 (65%) women were on ART, 410 (27%) on ZDV only, 109 (7%) on no ARVs, and 3 (0.2%) with unknown antiretroviral status. Among women on ART, 360 (37%) were receiving Atripla, 355 (36%) ZDV/3TC/NVP, 130 (13%) TDF/FTC/ NVP, 47 (5%) TDF/FTC/LPV/r, 42 (4%) ZDV/3TC/LPV/r, and 43 (4%) other or unspecified ART regimens. Among 1452 (96%) infants with known HIV status at 6 months, 30 (2.1%) were HIV positive. MTCT was more common among infants born to women on ZDV-only (N=13, 3.2%) than on ART during pregnancy (N=8, 0.8%)(aOR 3.0, 95% CI 1.1, 8.1). Mortality at 6 months was similar in the pregnancy ZDV and ART exposure groups (4% and 3%, respectively), yielding an advantage in HIV-free survival of 2.6% in the pregnancy ART-exposed group (aOR 2.0, 95% CI 1.0, 4.0).

Poster Abstracts

Conclusions: Among live-born infants followed through 6 months of life, HIV-free survival was improved when women received ART in pregnancy compared with ZDV alone, providing reassurance that the benefits of ART in pregnancy (including Atripla) are likely to exceed the risks. Further studies are needed to evaluate first-trimester Atripla exposure and risk of congenital abnormalities and stillbirths.

525

CROI 2015