CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: We examined hair concentrations of ARVs in relation to virologic outcomes in pregnant and postpartumwomen for the first time. Hair concentrations of EFV and LPV were the strongest predictors of viral suppression at delivery and 24 weeks postpartum, surpassing self-reported adherence and pretreatment HIV-1 RNA. Hair concentrations are an innovative tool for measuring long-term ARV adherence and exposure and may be helpful to monitor women during the critical peripartum period. 888 Side Effects and Treatment Adherence After ART Initiation in Pregnancy in South Africa Tamsin Phillips 1 ; AllisonV. Zerbe 2 ; Agnes Ronan 1 ; Claude A. Mellins 3 ; Robert H. Remien 3 ; James A. McIntyre 4 ; Greg Petro 1 ; Elaine J. Abrams 2 ; Landon Myer 1 1 University of Cape Town, Cape Town, South Africa; 2 ICAP at Columbia University, New York, NY, US; 3 New York State Psychiatric Institute and Columbia University, New York, NY, US; 4 Anova Health Institute, Johannesburg, South Africa Background: Recent guideline changes call for use of triple-drug antiretroviral therapy (ART) in all HIV-infected pregnant women in South Africa. However there have been few studies on side effects (SE) after ART initiation in pregnancy and their impact on ART adherence. Methods: Consecutive pregnant women seeking antenatal care (ANC) in Gugulethu, Cape Town were recruited at first ANC visit. Women initiated a once-daily fixed-dose combination of TDF300mg+FTC300mg+EFV600mg and attended scheduled assessments throughout the antenatal period to delivery. Structured questionnaires assessed self-reported SE, based on Division of AIDS categories, and missed ART doses in the preceding 30 days. The frequencies of different classes of SE were examined; multiple logistic regression was used to investigate adjusted associations between SE and non-adherence during the first two months on ART. Results: From April 2013–May 2014, 471 women were enrolled (median age, 28 years; median nadir CD4 cell count, 343 cells/ m L; median gestational age, 21 weeks). During the first two months on ART 92% of women reported at least one SE and 14% reported at least one missed dose (Table 1). Central nervous system (CNS) SE (dizziness, unusual dreams, headaches) were most commonly reported (73% of women), followed by gastrointestinal tract (GIT) SE (66%), and skin SE (predominantly rash, 19%); in addition, 63% reported non-specific systemic SE (fatigue, fever, generalised pain). Self-report of missing any ART during the preceding 30 days was more common in women who reported any skin or GIT SE (p=0.008 and 0.031, respectively) but non-adherence was not associated with CNS or systemic SE. After adjusting for age and duration of ART use, women’s reporting of skin SE remained associated with non-adherence (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.27-4.27) but GIT SE was only weakly associated with non-adherence (OR 1.79, 95% CI, 0.94-3.40).

Poster Abstracts

Conclusions: These novel data show a high frequency of self-reported SE in pregnant women starting ART in a primary care setting, and suggest that specific SE may contribute to non-adherence in the first months on ART. This SE frequency is higher than reported in non-pregnant adults in South Africa and the reasons for this require additional investigation. Interventions to reduce SE (e.g. lower EFV dosing) and/or mitigate the behavioural impact of SE (e.g. counselling interventions) require particular attention in the context of pregnancy. 889 Efficacy of Mobile Phone Use on Adherence to Nevirapine Prophylaxis and Retention in Care Among HIV-Exposed Infants Lilian M. Kebaya ; DaltonWamalwa; Nyambura Kariuki; Bashir Admani; RuthW. Nduati University of Nairobi, Nairobi, Kenya Background: HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal ARV regimens and only a minority of HIV- exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Rapid expansion of mobile phone coverage in Africa, and in Kenya, presents an opportunity to strengthen linkages between caregivers and health providers. Mobile phone use offers an option to improving care and promoting retention for the mother-baby pairs, which is a major challenge in efforts to achieving an HIV-free generation. Objectives: To compare self-reported adherence to infant nevirapine (NVP) prophylaxis and retention in care over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control). Design: Open label Randomized controlled trial

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CROI 2015