CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

831 PRENATAL ANTIRETROVIRAL EXPOSURE AND RISK OF LOW BIRTH WEIGHT IN LUSAKA, ZAMBIA Jennifer Winston 1 , Margaret P. Kasaro 1 , Marie Stoner 1 , Lloyd Mulenga 2 , Joan T. Price 1 , Elizabeth M. Stringer 1 , Benjamin H. Chi 1 , Bellington Vwalika 2 , Jeffrey S. Stringer 1 1 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 2 University of Zambia, Lusaka, Zambia Background: Antiretroviral therapy (ART) is recommended for all HIV-infected pregnant women, but some studies suggest that regimens containing protease inhibitors and/or tenofovir are associated with adverse birth outcomes. We investigated the association between antiretroviral drug exposure and low birthweight (LBW; <2500g) using data from two cohorts from Lusaka, Zambia (2008-2012). Methods: This analysis pooled data from (1) the MEP Study, which enrolled women who became pregnant while on ART, and (2) the UTH-AIDC cohort, which included women who started ART at a tertiary care hospital either before or during pregnancy. In each cohort, ART initiation was based on clinical stage (WHO 3 and 4) and/or CD4 count (<350 cells/mm 3 ). Consistent with an evolving standard of care at the time, ART regimens included an NRTI/NtRTI backbone (AZT+3TC, TDF+FTC) plus either an NNRTI (EFV, NVP) or PI (LPV/r). We considered each discrete regimen separately, but also combined those containing TDF backbone to evaluate any association between drug exposure and LBW. We estimated uni- and multivariate risk ratios using log-Poisson models. Results: Our pooled analysis included 674 HIV-infected pregnant women. Prescribed regimens included TDF+FTC+LPV/r (n=13, 2.1%), TDF+FTC+EFV (n=192, 31%), AZT+3TC+LPV/r (n=28, 4.6%), and AZT+3TC+EFV (n=380, 62%). In univariate models, when compared to those taking AZT+3TC+EFV, women taking TDF+FTC+LPV/r (RR 2.4; 95%CI 1.1–4.9) and TDF+FTC+EFV (RR 1.4; 95%CI 1.0–2.0) had higher risk for LBW infant. AZT+3TC+LPV/r was not associated with LBW. In a multivariable model, this trend remained for TDF+FTC+LPV/r (RR 1.9; 95%CI 0.9–3.8) and TDF+FTC+EFV (RR 1.3; 95%CI 0.9 – 1.9), but was no longer significant. In models comparing regimens with a TDF backbone to those with an AZT backbone, TDF was associated with an elevated risk of LBW in univariate models (RR 1.5; 95%CI 1.0-2.0) and multivariate models (RR 1.4; 95%CI 1.0–2.0). Conclusion: In this pooled secondary analysis, in utero exposure to TDF was associated with modest elevations in LBW risk. Further research is needed about the safety of TDF-based regimens, given the growing number of HIV-infected pregnant women initiating lifelong ART.

Background: In the era of universal HAART, concerns remain that triple- therapy may increase adverse pregnancy outcomes. We compared preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) in infants born to ART-experienced women to HIV-uninfected women in Blantyre, Malawi, where first-line ART includes tenofovir, lamivudine, and efavirenz. Methods: We enrolled HIV-infected and uninfected women and their infants at delivery into a one-year prospective study at five health-facilities in Blantyre, Malawi. Eligibility included confirmed HIV status, consent, singleton births, CD4>350 cells/mL3, and no stage 3/4 HIV. We documented sociodemographic data, clinical and reproductive history, birth weight and gestational age. LBW was defined as birth weight <2.5 kg, PTB was defined as gestational age <37 completed weeks gestation (Ballard Score), and SGA was defined as <10th percentile of birth weight of a standard population (Very SGA was defined as <3rd percentile). We applied logistic regression to measure the association between HIV and LBW and PTB. Odds ratios and 95% CIs are presented. Results: 685 HIV-uninfected and 593 HIV-infected women on ART were enrolled from January 2016 to mid-September 2017. 72.5% of the HIV-infected women were virally suppressed at baseline (<40 copies per/mL). Rates of PTB were 10.1% among HIV-infected women and 9.5% among uninfected women (p=0.71) and rates of LBWwere 6.9% among HIV-infected women and 4.9% among HIV-uninfected women (p=0.15). The rates of SGA (and Very SGA) were 17.4% (7.7%) among HIV-infected women and 18.3% (7.2%) among HIV-uninfected women (>0.05). In multivariate analyses (See Table), there was no association between HIV status and PTB after controlling for other factors. There was a moderately statistically significant association between being HIV-infected (and on ART) and LBW (adjusted OR=1.81; p=0.04) after adjusting for potential risk factors (Table). The rate of PTB was 13.0% (36/277) among HIV-infected women who started ART before pregnancy; 6.6% (17/257) among women starting ART during first or second trimester; and 12.1% (7/58) among women starting ART in third trimester. Conclusion: The adverse pregnancy outcomes of PTB and SGA were not different between healthy HIV-infected women and HIV-uninfected women. It appears that near-universal ART can eliminate mother-to-child transmission of HIV without substantially impacting other pregnancy outcomes.

Poster Abstracts

833 HIGH RATES OF ADVERSE BIRTH OUTCOMES IN SYPHILIS & HIV COINFECTED WOMEN IN BOTSWANA

Emily Shava 1 , Sikhulile Moyo 1 , Modiegi Diseko 1 , Rebecca Zash 1 , Eldah N. Dintwa 2 , Lucy Mupfumi 1 , Judith Mabuta 1 , Gloria Mayondi 1 , Jennifer Y. Chen 1 , Shahin Lockman 1 , Mompati O. Mmalane 1 , Joseph Makhema 1 , Roger L. Shapiro 1 1 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 2 Botswana Ministry of Health, Gaborone, Botswana Background: HIV and syphilis infections each cause morbidity to mother and/or infant as well as adverse birth outcomes in Sub-Saharan Africa. Little is known about the impact of HIV and syphilis co-infection in pregnant women and the impact on birth outcomes. Methods: Data from antenatal and obstetric records were abstracted from women who delivered at multiple government-run maternity wards in Botswana between 2008-2011 (5 sites) and 2014-2016 (8 sites). Antenatal HIV and syphilis test result, and infant birth record were collected in both time

832 PREGNANCY OUTCOMES IN THE ERA OF UNIVERSAL HAART IN AFRICA (THE POISE STUDY) Sufia Dadabhai 1 , Luis Gadama 2 , Rachel Chamanga 2 , Rachel Kawalazira 2 , Chaplain Katumbi 2 , Dingase E. Dula 2 , Isaac Singini 3 , Leslie Degnan 2 , Melvin C. Kamanga 2 , Taha E. Taha 4 1 Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre, Malawi, 2 Malawi Coll of Med–Johns Hopkins Univ Rsr Proj, Blantyre, Malawi, 3 University of Cape Town, Cape Town, South Africa, 4 The Johns Hopkins University, Baltimore, MD, USA

CROI 2018 314