CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

782 GROWTH OUTCOMES OF HIV-EXPOSED UNINFECTED CHILDREN BY BIRTH PERIOD IN MALAWI Malango T. Msukwa 1 , Andreas Haas 2 , Lyson Tenthani 1 , Cristina B. Hofer 2 , Janne Estill 2 , Frank M. Chimbwandira 3 , Adrian Spoerri 2 , Joep J. van Oosterhout 4 , Olivia Keiser 2 , for the Umoyo Study Group 1 Univ of Bern, Lilongwe, Malawi, 2 Univ of Bern, Bern, Switzerland, 3 Ministry of Hlth, Lilongwe 3, Malawi, 4 Dignitas Intl, Zomba, Malawi Background: There is concern that in-utero ARV exposure may impair the development of HIV exposed uninfected children. We compared weight-for-age-z-scores up to two years of life of HIV exposed uninfected children who were retained in care and born either in the pre-Option B+, transition or Option B+ periods. Methods: This was a retrospective cohort analysis of routine data on HIV exposed-uninfected children born between October 2009 and December 2014 from 21 health facilities in Malawi. We included all HIV exposed children with known sex, baseline weight, with at least one follow-up weight measurement and one valid HIV test result. We excluded children with either a positive HIV-1 DNA test result or a positive HIV antibody test that was taken ≥12 months after birth. We used linear mixed effects models to assess weight- for-age-z-scores until 24 months of age according to the child’s birth period. We defined birth period as pre-Option B+ if born before September 2011, transition if born between September 2011 and May 2012 and Option B+ if born after May 2012. Results: We included 6,993 children (median follow-up duration 15.0 months; IQR 8.5 - 21.5 months); 12.1%were born in the pre-Option B+ period, 20.7% in the transition period and 67.3% in the Option B+ period. There were no significant differences in birth weight (p = 0.377) and sex (p = 0.833) among children born in the three birth periods. Children born during the Option B+ period experienced faster longitudinal growth than those born in the pre-Option B+ period (adjusted β 0.29 [95% CI 0.20; 0.38], p < 0.0001). Lower weight-for-age z-scores over time were independently associated with low birth weight and non-exposure of the baby to prophylaxis ARVs at birth, but not with mother exposure to ART during pregnancy or triple combination ART during labour. Conclusion: After the introduction of Option B+more intensive exposure to ARV’s during pregnancy did not affect birth weight and the growth rate of HIV exposed uninfected children improved, possibly due to effects related to improved health of the mothers. 783 GROWTH IN INFANTS EXPOSED TO EFV AND TDF THROUGH BREASTMILK: MALAWI PMTCT OPTION B+ Atupele P. Kapito-Tembo 1 , Austin Wesevich 2 , Andy Bauleni 1 , Mina C. Hosseinipour 2 , Dennis Ongubo 2 , Queen Dube 3 , Amanda Corbett 4 , Don Mathanga 1 , Victor Mwapasa 1 , Sam Phiri 5 1 Univ of Malawi, Blantyre, Malawi, 2 Univ of North Carolina Proj–Malawi, Lilongwe, Malawi, 3 Ministry of Hlth Queen Elizabeth Central Hosp, Blantyre, Malawi, 4 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 Lighthouse Trust, Lilongwe, Malawi Background: Pregnant and breastfeeding women in Option B+ program in Malawi receive lifelong antiretroviral drugs (ARVs) containing efavirenz (EFV), tenofovir (TDF) and lamivudine. HIV-infected children on therapeutic doses of these drugs have experienced growth, renal, and bone metabolism adverse effects. Effects of long-term exposure to low doses of these drugs through breastmilk in HIV-exposed infants are unclear. Methods: A prospective cohort of HIV-exposed breastfeeding infants of HIV-positive mothers on ARVs and control group of HIV-unexposed breastfeeding infants of HIV-negative mothers were recruited in 2:1 ratio and followed from birth through 12 months. Preterm infants were excluded. Length, weight, mid-upper-arm-circumference (MUAC) and head- circumference (HC) were assessed at birth, 6-weeks, 3, 6, and 12 months. Creatinine, alkaline-phosphatase and phosphorus were assessed at 3, 6, and 12 months. Anthropometric

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