CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: It is largely reported that PLHIV in Africa are highly affected from parasite infections and that co-infections may adversely impact on their immune status, accelerating progress to AIDS and worsening gastrointestinal manifestations. On the contrary, in this study, the presence of Blastocystis was associated with a better immune status jointly with a healthy weight. This data is in accordance with the recent suggestions that Blastocystis may represent a component of the healthy gut microbioma. 803 INCREASED RISK OF HYPERTENSION IN PREGNANCY AMONG WOMEN ON NEVIRAPINE-BASED REGIMENS Rebecca Zash 1 , Paige L. Williams 2 , Denise Jacobson 2 , Modiegi Diseko 3 , Gloria Mayondi 3 , Judith Mabuta 3 , Katherine Johnson 1 , Mompati O. Mmalane 3 , Max Essex 2 , Shahin Lockman 4 , Joseph Makhema 3 , Chipo Petlo 5 , Roger L. Shapiro 2 1 Beth Israel Deaconess Medical Center, Boston, MA, USA, 2 Harvard University, Cambridge, MA, USA, 3 Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana, 4 Brigham and Women’s Hospital, Boston, MA, USA, 5 Ministry of Health, Gaborone, Botswana Background: Non-pregnant women on nevirapine(NVP)-based antiretroviral therapy (ART) have increased risk of incident hypertension. We evaluated the risk of hypertension in pregnancy by ART regimen in Botswana. Methods: Data were collected from all live and stillbirths <=24 weeks gestational age (GA) at 8 hospitals throughout Botswana (~45% of nationwide births). We recorded maternal demographics, medical history, HIV and ART history, and blood pressures and weights during antenatal care. Women were included if they started ART prior to pregnancy, with either zidovudine/ lamivudine (ZDV/3TC) or tenofovir/emtricitabine (TDF/FTC) combined with NVP, lopinavir-ritonavir (LPV/r) or efavirenz (EFV). Using log binomial regression, we compared risk of any hypertension (SBP >=140 or DBP >=90), severe hypertension (SBP >=160 or DBP >=110), gestational hypertension (onset of hypertension >=20 weeks GA) and early gestational hypertension (onset of gestational hypertension <34 weeks GA) by maternal ART regimen at conception, adjusting for potential confounders (maternal age, occupation, parity, weight and alcohol/tobacco use). Results: From Aug 2014-Aug 2016, 5087 women on NVP, LPV-r or EFV-based ART from conception delivered singletons at a surveillance maternity. Of these, 4915 (97%) had at least 1 blood pressure recorded in pregnancy including 2128 (43%) on NVP-based ART and 2797 (57%) on non-NVP based ART. Overall 1090 (22%) had hypertension, 106 (2.2%) had severe hypertension, 691 (14%) had gestational hypertension and 438 (9%) had early gestational hypertension. In adjusted analyses, women on NVP-based regimens were more likely to have hypertension (30% vs. 16%), severe hypertension (3.3% vs. 1.2%), gestational hypertension (18% vs.10%) and early gestational hypertension (12% vs. 7%) compared with women on non-NVP based ART (Table 1). There was no difference in outcomes when NVP was combined with ZDV/3TC vs. TDF/FTC except for severe hypertension which was more common in ZDV/3TC/NVP (6% vs. 2%). There were 48 stillbirths (7.8%) among hypertensive women on NVP, 25 stillbirths (5.6%) among hypertensive women on non-NVP containing ART, and 88 (2.3%) stillbirths among non-hypertensive women. Although hypertensive women on NVP accounted for only 13% of the population, they had 30% of the stillbirths. Conclusion: HIV-infected women on NVP-based ART have increased risk of developing gestational, severe and early hypertension in pregnancy, which may explain their increased risk for stillbirth.

during the follow-up. Two patients were loss to follow-up whereas 5 patients died, none of them related to CMV infection. Twenty-nine (69.0%) patients had a positive CMV-specific immune response at baseline and 16 (88.9%) patients at the end of the study. We observed a significant increase of the CMV-specific IFN-γ response among the 20 patients who have already completed the study (p=0.029) Conclusion: The prevalence of CMV viremia in patients with advanced HIV infection is high. However, the incidence of CMV-EOD is low due to the presence of specific immunological response to CMV, which improves after starting HAART. These findings suggest that CMV specific treatment might not be necessary in these patients.

Poster Abstracts

802 BLASTOCYSTIS INFECTIONS IN HIV POSITIVE AND NEGATIVE ADULTS IN GHANA Veronica Di Cristanziano 1 , Federica Berrilli 2 , Rossella D’Alfonso 2 , Fred S. Sarfo 3 , Lavinia Fabeni 4 , Elena Knops 1 , Eva Heger 1 , Albert Dompreh 5 , Rolf Kaiser 1 , Torsten Feldt 6 , Kirsten Eberhardt 7 1 University of Cologne, Cologne, Germany, 2 University of Rome Tor Vergata, Rome, Italy, 3 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, 4 Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy, 5 Komfo Anokye Teaching Hospital, Kumasi, Ghana, 6 Heinrich Heine University Düsseldorf, Düsseldorf, Germany, 7 Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany Background: Sub-Saharan Africa is endemic for intestinal parasites and distinguished for the largest burden of HIV cases. Blastocystis is one of the most common intestinal protists infecting humans but its role in human disease is still under debate. We investigated the prevalence of Blastocystis infection in HIV positive and negative people living in Ghana and its association with immune status and other risk factors. Methods: 122 HIV positive patients with CD4+ T count <200 cells/µl (n=54) and >200 cells/µl (n=68) presenting to the HIV outpatient Department of the Komfo Anokye Teaching Hospital in Kumasi, Ghana, and 70 HIV negative blood donors from the same hospital were included in the present study. Demographic and clinical data were collected. For Blastocystis detection the small subunit (SSU) rRNA amplification was carried out. A phylogenetic analysis on Blastocystis Sanger sequences was performed to determine sample subtype. Samples from symptomatic subjects were screened for the presence of common pathogens by xTAG GPP (Luminex Molecular Diagnostics) and FTD Viral gastroenteritis (Fast-Track Diagnostics). Results: The overall prevalence of Blastocystis in 192 adults was 11.5% (n=22) with a lower prevalence in HIV positive individuals than in HIV negative persons (6.6% vs. 20.0%, p=0.008). Within HIV positive participants, the prevalence of Blastocystis was lower in those individuals with CD4+ T cell count of <200 cells/ µl than in patients with higher CD4+ T cell count (1.9% vs. 10.3%, p=0.076). In HIV negative persons, Blastocystis was associated with lower CD4+ T cell counts and a higher BMI (p=0.025 and p=0.011 respectively). Presence of Blastocystis was correlated with higher CD4+ T counts in HIV positive persons (p=0.035). Remarkably, only 4 subjects with Blastocystis infection were affected from gastrointestinal symptoms and all of those were detected positive for other enteric pathogens. Phylogenetic analysis revealed that Blastocystis subtype 1 was the most prevalent strain.

CROI 2018 302