CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Methods: Echocardiographic measures of left ventricular (LV) systolic and diastolic function and cardiac structure were obtained in HEU children aged 6 years and older enrolled in the PHACS Surveillance Monitoring of ART Toxicities (SMARTT) Study. Echocardiographic Z-scores were calculated using normative data from an established reference cohort of healthy children from Boston Children’s Hospital, with adjustment for age and body-surface area, as appropriate. We used adjusted linear regression models and latent variable models to compare Z-scores for echocardiographic measures from HEU children exposed in utero to HAART with those exposed to non-HAART antiretroviral (ARV) therapy, adjusting for demographic and maternal health characteristics including substance use. Results: 174 HEU subjects with echocardiograms and maternal ARV information were included (mean age at echocardiogram=10.9 years; 48%male, 56% Black non-Hispanic). We observed no differences in Z-scores for LV systolic function measures for those exposed in utero to HAART (39%) compared to HAART-unexposed in either unadjusted or adjusted models. In adjusted models, those exposed to HAART, as compared to HAART-unexposed, had significantly lower mitral late diastolic inflow velocities (adjusted mean Z-score=0.00 vs 0.52, p=0.04), and significantly higher adjusted mean LV mass-to-volume ratio Z-scores (adjusted mean Z-score=0.47 vs 0.11, p=0.03). There were no associations observed between ARV exposure in the first trimester and any LV systolic or diastolic echocardiogrammeasure. Conclusions: Uninfected youth with perinatal exposure to HAART had no difference in LV systolic function. However, small but significant differences in LV diastolic function and cardiac structure were observed, suggesting that continued monitoring for cardiac outcomes is warranted in this population.

THURSDAY, FEBRUARY 26, 2015 Session P-T5 Poster Session

Poster Hall

2:30 pm– 4:00 pm Coinfections Among HIV-Exposed Infants and Children 883 Burden of Malaria in a Birth Cohort of HIV-Exposed Ugandan Infants Abel Kakuru 2 ; Paul Natureeba 2 ; Albert Plenty 1 ; Edwin Charlebois 1 ; Deborah Cohan 1 ;Tamara Clark 1 ; Diane Havlir 1 ; Moses R. Kamya 3 ; Grant Dorsey 1 ; Theodore Ruel 1 1 University of California San Francisco, San Francisco, CA, US; 2 Makerere University-University of California, San Francisco Research Collaboration, Kampala, Uganda; 3 Makerere University College of Health Sciences, Kampala, Uganda Background: HIV-exposed infants suffer high mortality in the first year of life, but accurate data on the burden of malaria are lacking. We evaluated the incidence of febrile illnesses and malaria in a birth cohort born to HIV-infected women living in a hyper-endemic area of rural Uganda where the incidence of malaria in a contemporaneous cohort of HIV-unexposed infants aged 6-12 months was over 5 episodes/person-year. Methods: In the PROMOTE trial (NCT00993031), HIV-infected pregnant women were randomized to either efavirenz- or lopinavir- based therapy. Infants were given insecticide treated bednets at birth, cotrimoxazole prophylaxis at 6 weeks of age, and followed for all their health care needs in the study clinic until 12 months of age. All febrile episodes were evaluated with blood smears for malaria and if present, treated. Risk factors for malaria were assessed using generalized estimating equations. Results: Of 361 infants born to 377 HIV-infected mothers and surviving beyond 24 hours, 19%were low birth weight (< 2500 gm), 17 were pre-term (< 37 weeks), and 34% had evidence of placental malaria by histopathology. In 305 patient-years (py) of follow up, there were 1561 febrile episodes (5.1/py) and 265 episodes of malaria (0.87/py). The incidence of febrile illnesses increased modestly after 4 months of age (Figure). In contrast, the incidence of malaria incidence increased dramatically over the first year of life (p<0.001, Figure) with only 2 episodes of malaria in infants under 2 months of age, neither of whom had started cotrimoxazole. The proportion of febrile illnesses that were malaria increased from< 1% at 0 -2 months of age to over 37% by 11-12 months of age. Low birth weight, prematurity, maternal study arm, and placental malaria were not significantly associated with malaria during the first year of life. There were no episodes of WHO-classified complicated malaria, 6 deaths (none frommalaria), and 2 cases of HIV transmission.

Poster Abstracts

Conclusions: HIV-exposed infants living in a hyper-endemic area who had access to cotrimoxazole prophylaxis and prompt malaria treatment experienced lower rates of malaria than HIV-unexposed infants, with no complicated malaria or malaria mortality. These results underscore the importance of accurate malaria testing and the consideration of non- malarial infectious etiologies in reducing the morbidity and mortality of HIV-exposed infants, especially those < 6 months of age. 884 CMV Transmission FromHIV-infectedWomen Randomized to Formula Versus Breastfeeding Barbra Richardson 1 ; Grace John-Stewart 1 ;Vincent Emery 2 ; Claire Atkinson 4 ; Ruth Nduati 3 ; Kristjana H. Ásbjörnsdóttir 1 ; Julie M. Overbaugh 5 ; Michael Boeckh 5 ; Jennifer A. Slyker 1 1 University of Washington, Seattle, WA, US; 2 University of Surrey, Guildford, United Kingdom; 3 University of Nairobi, Nairobi, Kenya; 4 University College London, London, United Kingdom; 5 Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, US Background: Cytomegalovirus (CMV) is associated with infant HIV disease progression. We compared rates of CMV infection between breastfed (BF) and formula fed (FF) infants and determined the relative proportion of infections attributable to congenital, intrapartum, breast milk, and other modes of transmission. Methods: Between 1993-1998 pregnant, HIV-infected women from Nairobi, Kenya, were randomized at 32 weeks gestation to breastfeed or formula feed their infants in a study designed to compare rates of vertical HIV transmission (Nduati et al, JAMA 2000). Blood was collected serially over 2 years. We evaluated CMV acquisition as an additional study

532

CROI 2015