CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

z-scores were calculated using the WHO Child Growth Standards Anthro 2011 software version 3.2.2. Means and 95% confidence intervals of the z-scores were calculated. For biochemistry laboratory tests, Division of AIDS 2014 toxicity tables version 2 were used, with grades 1, 2, 3, and 4 defining mild, moderate, severe, and life-threatening events. Results: Of the total 260 HIV-exposed breastfeeding infants with EFV and TDF exposure in breastmilk and 125 HIV-unexposed breastfeeding infants enrolled at birth, 87% and 99%; 83% and 62%; 79% and 59%; 74% and 51% completed 6 weeks, 3, 6, and 12 months visits respectively. There were no significant differences in the mean z-scores for length-for-age, weight-for-age, MUAC-for-age and HC-for-age between the two groups except at 6 weeks for length-for-age (refer to figure). There was no report of bone fracture occurrence. Of 677 and 688 creatinine and alkaline-phosphatase measurements, 2.5% and 2.6% reached toxicity levels respectively, however, there were no significant differences between the two groups at all visits. Conclusion: Among infants of HIV-infected mothers on lifelong ARVs, long-term exposure to EFV and TDF through breastfeeding does not appear to result in growth, renal, or bone adverse outcomes. These data support the safety of breastfeeding of HIV-exposed children at 12 months in the context of PMTCT Option B+.

Poster and Themed Discussion Abstracts

784 PREDICTORS OF NEURODEVELOPMENT IN CHILDREN OF HIV-INFECTED AND -UNINFECTED WOMEN

Jean Leidner 1 , Paige L. Williams 2 , Gloria Mayondi 3 , Penny Holding 4 , Adam Cassidy 5 , Joseph Makhema 3 , Chipo Petlo 6 , Charlotte Mdluli 3 , Shahin Lockman 2 , Betsy Kammerer 5 1 Goodtables Consulting, Oklahoma, OK, USA, 2 Harvard Univ, Boston, MA, USA, 3 Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana, 4 Independent Consultant, Nairobi, Kenya, 5 Boston Children’s Hosp, Boston, MA, USA, 6 Ministry of Hlth, Botswana, Gaborone, Botswana Background: We previously found equivalent neurodevelopmental scores in HIV-exposed, uninfected (HEU) and HIV-unexposed (HU) 24 month-old children in Botswana. Yet, the impact of other maternal, socio-economic, and infant birth characteristics on neurodevelopment remains unclear. We examined the association between these factors and neurodevelopmental scores in HEU and HU children at 24 months of age. Methods: We enrolled HIV-infected and HIV-uninfected mothers (during pregnancy or within 1 week postpartum) and their babies in the prospective observational “Tshipidi” study in 2 sites in Botswana (1 urban and 1 rural) fromMay 2010 -July 2012. Live born infants and their mothers were followed for 24 months, with data on socio-demographic, health, and psychosocial characteristics collected at baseline and periodically during follow-up. Assessment of neurodevelopmental outcomes at 24 months of age included the Bayley Scales of Infant and Toddler Development III The Bayley contained 3 domains: Cognitive, Motor (Fine and Gross), and Language (Expressive and Receptive); each of these was modified for cultural appropriateness, and scored and analyzed separately. Results: Among the 910 (453 HEU, 457 HU) infants enrolled, 670 (313 HEU, 357 HU) had one or more valid Bayley scores prior to 30 months of age, 90% of whom attempted the entire assessment. In univariate analyses, mean scores were associated with multiple predictors. Low birth weight (LBW), being male, younger maternal age, less maternal education, lack of indoor plumbing and a stove, food insecurity, and maternal tobacco use and depression were associated with worse scores. All factors remained significant after multivariable adjustment, except food insecurity and maternal depression. The relationship between higher maternal education and better scores was particularly strong among HEU children. These education-related increases in mean Cognitive and Expressive and Receptive Language scores were reflected by effect sizes of 0.26, 0.50, and 0.26, respectively (p<0.05). This relationship was not seen in HU children. Multivariable adjustment attenuated the effect of socio-economics in both exposure groups. Conclusion: Multiple maternal, child and home environment factors impact development in both HIV exposed and unexposed children in Botswana. These data provide guidance in choosing support services for both mothers and children, particularly HEUs, to promote the child’s cognitive, motor, and language development.

CROI 2017 340