CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

872 Infant Outcomes Among a Cohort of HIV-Infected Pregnant WomenWith andWithout TB in South Africa: The Tshepiso Study Jennifer D. Hoffmann 1 ; Silvia E. Cohn 1 ; Nicole M. Salazar-Austin 1 ; Fildah Mashabela 2 ; ZiyaadWaja 2 ; Christopher J. Hoffmann 1 ; Sanjay Lala 3 ; Richard E. Chaisson 1 ; Neil A. Martinson 2 1 Johns Hopkins University School of Medicine, Baltimore, MD, US; 2 Perinatal HIV Research Unit (PHRU), Johannesburg, South Africa; 3 Chris Hani Baragwanath Hospital, Johannesburg, South Africa Background: Perinatal morbidity in infants born to mothers with TB/HIV is higher than in infants born to mothers with HIV only. Infants of mothers with TB are more likely to suffer from perinatal death, prematurity, intrauterine growth retardation, and low birth weight. Higher rates of HIV MTCT have been reported among neonates born to mothers with HIV/TB co-infection. Methods: Tshepiso is a prospective cohort study of HIV-infected pregnant women with active TB (cases) matched 1:2 with HIV-infected pregnant women without diagnosed active TB (controls) in Soweto, South Africa. Women are followed through pregnancy, peripartum and postpartum to record maternal and infant HIV, TB and overall clinical outcomes. All infants receive HIV prophylaxis with nevirapine (NVP) and underwent HIV DNA testing at 3-7 days, 6 weeks, and 6 and 12 months. Infants born to TB cases were referred for evaluation for congenital TB and initiation of TB prophylaxis with either isoniazid or isoniazid/rifampin. We describe here the infant clinical outcomes of the cohort. Results: From January 2011 to June 2014, we enrolled 232 (median age 29 years) HIV-infected pregnant-women, 79 cases with active TB and 153 as non-TB controls. Of 201 total births to date, there were 4 stillbirths, 2 (3%) and 2 (1.5%) to cases and controls, respectively. Median birth weights were similar in both cases and controls, but the percentage of low birth weight (LBW, <2500 g) was 19% among cases vs 11% among controls. There was a higher rate of infant mortality among cases (6.3%) than in controls (0.77%, p<0.05 ) . Among infants born to cases, 47 (76%) initiated TB prophylaxis within 30 days; 4 (5.8%) were diagnosed and treated for TB, vs 0 in control infants (p=0.01) There were 4 cases of MTCT of HIV transmission, 2 (3.2%) among cases and 2 (1.5%) among controls (p>0.10). 5 minute Apgar score <7 was 5% among cases and 1.5% among controls. Prematurity, congenital anomalies and growth throughout the first year of life did not differ significantly for infants born to maternal cases vs controls.

Conclusions: Our cohort revealed the TB/HIV exposed infants had significantly higher infant mortality rates than infants exposed to HIV only. There was a higher rate of MTCT among cases, but overall a low rate of transmission in the cohort. There is no difference in cases and controls at birth in terms of prematurity or median birth weight, but a trend towards higher rates of LBW and stillborn births among cases.

Poster Abstracts

TUESDAY, FEBRUARY 24, 2015 Session P-T3 Poster Session

Poster Hall

2:30 pm– 4:00 pm Option B+: Retention and Transmission 873 Early HIV Infection Rate Trends in Exposed Infants Pre- and Post-Option B+ in Mozambique Thresia Sebastian ; Serena Brusamento; Laurence Ahoua; Dario Aly; Stephen M. Arpadi; Chloe A.Teasdale; FatimaTsiouris; Elaine J. Abrams ICAP at Columbia University, New York, NY, US

Background: In June 2013, Mozambique adopted Option B+ which uses task shifting of ART care from clinical officers to nurses and the creation of a one-stop model at maternal/ child health services for pregnant women (PW) and their HIV exposed infants (HEI). Data from ten health facilities (earliest adopters of option B+) in Nampula and Zambezia provinces were analyzed pre and post B+ to assess maternal ART uptake and early infant diagnosis. Methods: Routinely collected aggregate data from ICAP-supported sites with antenatal care (ANC) and At Risk Child Clinic (ARCC), where HEI care is provided, were evaluated prior to and after implementation of B+. We compared uptake of care among PW and early infant (<=2 months of age) PCR positivity, using weighted paired t-tests comparing proportions across sites, one year pre and immediately post B+ implementation. Average gestational age at first ANC visit in Mozambique is around 20 weeks; therefore, delivery dates were estimated for PW and data on HEI were collected in the subsequent 4 month period. Data for the pre B+ group were collected for PW from July to Dec 2012 and for HEI from Nov 2012 to Apr 2013; in the post B+ group for PW from Jul to Dec 2013 and for HEI from Nov 2013 to Apr 2014. Proportions of early infant positivity were calculated using an estimate of the number of expected HEI calculated as 95% of HIV+ PW in ANC having live infants. Results: 22,299 PWenrolled in care pre-B+ and 25,522 were enrolled post B+. There was no statistically significant difference between pre and post B+ periods in the proportion of PWenrolled in ANC with known HIV status (91% vs 93%, p=0.25), proportion of PWwho were HIV+ (13% vs 12%, p=0.71) or proportion of HIV+ PW initiated on any ARVs (98% vs 94%,

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CROI 2015