CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

at the University of Washington between 1/1/2013-12/31/2016. Women who received 1mg cabergoline within 48 hours post-partum (N=28 HIV+, 43 HIV-) were compared to unexposed women (N=32 HIV+, 121 HIV-) who delivered before cabergoline was available on formulary. Women with hypertension and multiple gestations were excluded. Pulse, systolic and diastolic BP were assessed at 4-hour intervals up to 24-hours after cabergoline and compared to unexposed women using delivery as the reference point. Mean BP and pulse for the two groups were compared using linear regression to estimate mean change (β)and 95% confidence intervals (CI), adjusting for age, lactation suppression, indication and weeks’ gestation at delivery. Results: Among all 60 HIV+ women, 50 (83%) were diagnosed prior to pregnancy and 59 (98%) had HIV RNA <40 prior to delivery. ARV regimen type (PI, NNRTI, II) did not differ between cabergoline-exposed and unexposed women. Among the 28 HIV+ cabergoline-exposed women, 15 (54%) reported effective lactation suppression postpartum, 13 (46%) did not comment and 1 (3%) had breast engorgement/leaking; none reported adverse effects. Among HIV+ and HIV- women combined, cabergoline-exposed women had lower mean systolic BPs at all 4-hour time intervals ranging from -6.9mm Hg (95% CI -11.1 to -2.8) at 0-4 hours to -10.9 mm Hg (95% CI -18.2 to -3.6) at >20-24 hours compared to unexposed women. Diastolic BP was decreased on average –8.1mmHg (95% CI -13.9 to -2.4) at 20-24 hours only, with no significant differences found in maternal pulse between cabergoline-exposed and unexposed groups. Conclusion: Cabergoline has a modest lowering effect mainly on systolic blood pressure, which was statistically significant but unlikely to be clinically important given no change in maternal pulse. Cabergoline could be considered for more routine use among HIV+ and HIV- women with indications for lactation suppression.

FTC. Viral load and self-reported adherence were collected every 12 weeks. VF was defined as 2 consecutive viral loads >1,000 copies/mL after 24 weeks on ART. Viral re-suppression was defined as 2 consecutive viral loads 1,000 copies/ mL after VF. For this analysis, self-reported adherence was dichotomized as missing versus not missing ART doses in the prior 4 weeks. Predictors of VF and re-suppression were examined using Cox proportional hazards univariable and multivariable regression, with adherence as a time-varying covariate. Other predictors were values at baseline. Results: Among the 802 women randomized to continue ART, median age at entry was 27 years (IQR 23-32) and median CD4 696 cells/mm 3 (IQR 576-865). Participants were enrolled from South America/Caribbean (39%), Africa (28%), Asia (25%), and the United States (8%). Of 175 women with VF, 139 had resistance data available. Of these, 17/139 (12%) failed with resistance to their current regimen. There was an estimated 0.12 probability of VF by week 48, 0.20 by week 96, and 0.25 by week 144. In univariable regressions, self-report of any missed ART doses in the prior 4 weeks, younger age, region, and shorter duration of pre-entry ART were predictive of VF. In the final multivariable model for VF, significant predictors included missed ART doses within the prior 4 weeks, younger age, shorter duration of pre-entry ART, and region (South America/Caribbean) (Table). Among the 175 (22%) women with VF, the probability of re-suppression was 0.37 by 48 weeks, 0.48 by 96 weeks, and 0.57 by 144 weeks. There were no statistically significant predictors of re-suppression. Conclusion: A simple 4-week ART recall question predicted first VF among women in PROMISE 1077HS. Postpartumwomen who have VF are high risk for continued viremia, and further research should explore strategies that can successfully support ART adherence for this vulnerable population. 813 DISPARITIES IN ANTENATAL VIROLOGIC FAILURE AMONG WOMEN RECEIVING OPTION B+ IN KENYA Keshet Ronen 1 , Brian Khasimwa 2 , Bhavna Chohan 3 , Daniel Matemo 2 , Jennifer Unger 1 , Alison L. Drake 1 , John Kinuthia 2 , Grace John-Stewart 1 1 University of Washington, Seattle, WA, USA, 2 Kenyatta National Hospital, Nairobi, Kenya, 3 Kenya Medical Research Institute, Nairobi, Kenya Background: Option B+ prevention of mother-to-child transmission (PMTCT) regimens rely on maternal adherence to ART. It is important to determine rates and correlates of virologic failure in women receiving Option B+. This study evaluates the prevalence and correlates of virologic failure in a cohort of pregnant HIV-infected women receiving ART in public maternal child health (MCH) clinics in Kenya. Methods: We conducted a cross-sectional analysis of enrollment data from participants in a trial evaluating mHealth strategies to improve ART adherence (Mobile WAChX, NCT02400671). Participants were age ≥14, HIV- infected, pregnant and had daily access to a mobile phone. Participants were recruited from 6 public MCH clinics in Nairobi and Nyanza region. Self-report questionnaires, clinic record abstraction and plasma for viral load (VL) testing were collected. Virologic failure was defined as VL ≥1000 copies/ml among women with ≥6 months on ART. ART adherence behavior skills were assessed using a modified Lifewindows IMB tool and depression using the PHQ9. Correlates of failure were assessed by χ² test and univariable logistic regression with clustered standard errors by site. Results: Of 825 participants enrolled, 451 (56%) had been on ART ≥6 months, of whom all but one had VL data (n=450). Of these, 58 (13%) had virologic failure, 115 (26%) reported ≥mild depression (PHQ9 score ≥5), 433 (96%) had disclosed their HIV status to someone, median adherence behavior skills score was 81%, and median age was 28.5. Prevalence of virologic failure was associated with clinic site (range 1%-27%, p<0.0001), continuous age (OR per

Poster Abstracts

812 PREDICTORS OF VIROLOGIC FAILURE IN POSTPARTUMWOMEN ON ART IN PROMISE 1077HS Risa M. Hoffman 1 , Meredith G. Warshaw 2 , K. Rivet Amico 3 , Jose H. Pilotto 4 , Gaerolwe Masheto 5 , Jullapong Achalapong 6 , Elizabeth S. Machado 7 , Kulkanya Chokephaibulkit 8 , Geraldo Duarte 9 , Anne Coletti 10 , Renee Browning 11 , Nahida Chakhtoura 12 , Karin L. Klingman 11 , Judith S. Currier 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Harvard University, Boston, MA, USA, 3 University of Michigan, Ann Arbor, MI, USA, 4 Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, Brazil, 5 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 6 Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand, 7 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 8 Mahidol University, Bangkok, Thailand, 9 Universidad de São Paulo, São Paulo, Brazil, 10 FHI 360, Durham, NC, USA, 11 NIAID, Bethesda, MD, USA, 12 National Institute of Child Health and Human Development, Bethesda, MD, USA Background: Antiretroviral (ART) adherence can be challenging for postpartumwomen and may result in virologic failure (VF). We examined predictors of VF and viral re-suppression in postpartumwomen randomized to continue ART in PROMISE 1077HS. Methods: Asymptomatic HIV+, non-breastfeeding women with pre-ART CD4 cell counts 400 cells/mm 3 who started ART during pregnancy were randomized up to 42 days after delivery to continue or discontinue treatment. Women were enrolled from 12/2011-11/2014. The preferred regimen was LPV/RTV with TDF/

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