CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

938 INTERACTION BETWEEN ETONOGESTREL-RELEASING IMPLANT AND 3 ANTIRETROVIRAL REGIMENS Regis Kreitchmann 1 , Alice Stek 2 , Brookie Best 3 , Edmund Capparelli 3 , Jiajia Wang 4 , David E. Shapiro 4 , Nahida Chakhtoura 5 , Sandra Burchett 6 , Mark Mirochnick 7 , for the IMPAACT P1026s ProtocolTeam 1 Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil, 2 Univ of Southern California, Los Angeles, CA, USA, 3 Univ of California San Diego, La Jolla, CA, USA, 4 Harvard Univ, Boston, MA, USA, 5 NICHD, Bethesda, MD, USA, 6 Boston Children’s Hosp, Boston, MA, USA, 7 Boston Med Cntr, Boston, MA, USA Background: Long acting reversible contraceptives are highly efficacious and used to prevent unplanned pregnancies in HIV infected women worldwide. There are limited data on pharmacokinetic (PK) interactions between the etonogestrel releasing implant (ENG) and antiretroviral therapy. We evaluated both the effect of ENG on the PK parameters of 3 highly active antiretroviral (ARV) regimens including: ritonavir boosted atazanavir (ATV/r), ritonavir boosted lopinavir (LPV/r) or efavirenz (EFV) and the effect of these antiretrovirals on ENG levels in HIV infected postpartumwomen. Methods: IMPAACT P1026s is an ongoing, non-blinded international study of ARV PK in pregnancy and postpartum. We enrolled postpartumwomen who desired to use ENG implants and were taking ATV/r, LPV/r, or EFV-based regimens for at least 2 weeks. ENG implant was inserted between 2 and 12 weeks postpartum. PK sampling was performed before and 6 to 7 weeks after insertion. ARV and ENG concentrations (conc) were measured using liquid chromatography-mass spectrometry. The P1026s target minimum AUC for ATV, LPV and EFV were 29.4, 52 and 40 μg*hr/mL (10th percentile in non-pregnant historical controls), respectively. Median (range) ENG conc within the first few weeks of use in women not receiving ARV’s is 400 pg/mL (250-500 pg/mL). ENG conc >90 pg/mL is believed to reliably suppress ovulation. Results: PK data are available for 62 postpartumwomen (6 Black, 49 Hispanic, 7 Asian). Median (range) age at enrollment was 26.9 (15.8-41.1) yr, weight 62.7 (38.7-157.9) kg, median duration of LPV/r, ATV/r and EFV use before implant insertion was 30.0, 32.1 and 4.4 weeks, respectively. Median CD4 was 584/mm3 (79-1578) in 61 women and VL was <400 in 40/54 women (74.1%) before ENG initiation. Table 1 presents ENG concentrations and ARV AUCs among these three arms. Median ENG conc of EFV armwas <10% of the other two arms. ARV AUCs before and after ENG insertion did not differ significantly. Proportions of women meeting ARV PK targets before and after ENG insertion were: 77% and 66% for ATV/r, 84% and 84% for LPV/r and 90% and 81% for EFV (p=0.73). Conclusion: No significant change in ATV/r, LPV/r and EFV exposure was seen after ENG insertion. EFV use was associated with greatly decreased ENG conc to levels that may impair contraceptive efficacy. Co-administration of LPV/r and ATV/r with ENG resulted in adequate ENG conc, suggesting that these combinations should have no impact on implant efficacy.

939 FERTILITY AND REPRODUCTIVE OUTCOMES OF HIV+ AND HIV- WOMEN IN THE CARMA COHORT STUDY Clara E. Van Ommen 1 , Arianne Y. Albert 2 , Ariel Nesbitt 1 , Shanlea Gordon 3 , Evelyn J. Maan 3 , Helene C. Cote 1 , Neora Pick 1 , Deborah M. Money 1 , Melanie C. Murray 1 , for the CIHRTeam on Cellular Aging and HIV Comorbidities inWomen and Children (CARMA) 1 Univ of British Columbia, Vancouver, Canada, 2 Women’s Hlth Rsr Inst, Vancouver, Canada, 3 Oak Tree Clinic, Vancouver, Canada Background: Many women living with HIV are of reproductive age and desire children, yet the belief remains that HIV reduces fertility. The majority of studies exploring fertility and birth rates among HIV+ women are from the pre-combined antiretroviral therapy (cART) era, and report that HIV decreases fertility by 25-40%. There is little data on the impact of controlled HIV infection on reproduction in HIV+ women, though increased birth rates among women on cART versus the pre-cART era were reported. We hypothesize that Canadian women, with full access to cART, may experience a level of fertility similar to their HIV- peers.

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