CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

periods, and antimicrobial treatment data were collected in 2014-16. We used logistic regression techniques to describe adverse birth outcomes by HIV status amongst syphilis-infected women. Outcomes were stillbirth, preterm delivery (<37 weeks gestational age), low birth weight (<2500g), and in-hospital neonatal death (<28 days). Results: Of 76,466 women delivering in the two study periods, 75,770 (99.1%) had HIV test results, and 20,520 (27.1%) were HIV positive. Syphilis test results were available for 67,290 (88.0%) women, and 697 (1.0%) had reactive RPR/ VDRL. HIV co-infection was present in 37.7% (95% CI: 34.1 – 41.4) of the 692 women with syphilis who also had an HIV test result. HIV-infected women were more likely to be co-infected with syphilis compared with HIV-uninfected women (OR=1.68; 95%CI 1.44 – 1.96). Between 2008-2011 and 2014-2016, the proportion of women with syphilis remained constant (1.1% vs. 1.0%, p=0.41), while the prevalence of HIV/syphilis co-infection declined from 45% to 27% (p<0.0001). HIV/syphilis co-infected women had more stillbirth, preterm delivery and low birth weight infants compared with HIV mono-infected and syphilis mono-infected women (Table 1). Stillbirth was significantly more common among co-infected women than HIV mono-infected women (OR=1.75; 95%CI 1.03 – 2.97) and low birthweight was significantly more common among co-infected women compared to syphilis mono-infected women (OR=1.85; 95%CI: 1.26 – 2.74). Conclusion: Syphilis/HIV co-infection during pregnancy has declined in the past decade in Botswana. The mechanism by which HIV and syphilis combine to increase adverse birth outcomes requires further exploration.

more common among HIV+ women with stillbirths than HIV- women with stillbirths (58% vs. 33%, p=0.12), and also more common among HIV+ women with preterm-SGA than HIV- women with preterm-SGA (67% vs. 25%, p=0.15). Placental weight and maternal vascular malperfusion were similar by HIV status among infants who were preterm alone or full-term SGA. Among 11 HIV-infected women on efavirenz (EFV)-based ART with stillbirth, 5 (45%) had maternal vascular malperfusion compared with 17/ 23 (74%) of women on NVP- based ART and 6/14 (43%) on zidovudine monotherapy (from a prior placental stillbirth study in Botswana). Conclusion: Among women with stillbirth and preterm-SGA, HIV infection was associated with lower placental weight and maternal vascular malperfusion. Whether this finding is due to endothelial dysfunction from chronic HIV- infection or due to effect of specific ART needs further investigation.

Poster Abstracts

835 INFLAMMATION IN HIV-INFECTED PREGNANT WOMEN IS ASSOCIATED WITH PRETERM BIRTH Rupak Shivakoti 1 , Nikhil Gupte 1 , Nathella P. Kumar 2 , Vandana Kulkarni 1 , Usha Balasubramanian 3 , Ramesh Bhosale 3 , Pradeep Sambarey 3 , Aarti Kinikar 3 , Renu Bharadwaj 3 , Sandesh Patil 3 , Sadaf Inamdar 3 , Nishi Suryavanshi 1 , Subash Babu 4 , Robert Bollinger 1 , Amita Gupta 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 National Institute for Research in TB, Chennai, India, 3 BJGMC Clinical Trials Unit, Pune, India, 4 NIH, Bethesda, MD, USA Background: Preterm birth (PTB) is the leading cause of childhood morbidity and mortality. PTB rates are high in HIV-infected populations, even when on treatment. Still, only a subset of all births in HIV-infected pregnant women result in PTB, suggesting risk factors other than HIV infection itself are also important. While inflammation is a known risk factor in uninfected populations, the immune pathways involved are not clear and non-invasive immune markers with predictive value are lacking. Our objective was to determine the association of various markers of inflammation with PTB in HIV-infected pregnant women. Methods: Within a randomized trial of pregnant women receiving Nevirapine (SWEN trial), we nested a case-control study (n=107; 26 cases, 81 controls) to determine the association of maternal inflammation with PTB. Cases were defined as PTB (<37 weeks gestational age (GA)) and controls as term births. Inflammation was assessed using enzyme-linked immunosorbent assay to measure plasma levels of general inflammation markers (acute phase proteins including C-reactive protein (CRP) and alpha 1-acid glycoprotein (AGP)) and markers of microbial translocation (intestinal fatty acid binding protein (I-FABP) to assess intestinal integrity, and soluble CD14 (sCD14) and CD163 (sCD163) to assess monocyte activation). These markers were assessed in visits prior to birth and randomization (21-33 weeks GA). Multivariable logistic regression was used to estimate the adjusted odds of PTB per log2 increase of each marker. Results: In univariable and multivariable models adjusting for maternal age, BMI, education, parity, history of previous preterm birth, HIV treatment regimen, CD4 T-cell count and viral load (measured during time of inflammation assessment), there was increased odds of PTB per unit increase of Log2 AGP (adjusted odds ratio (aOR): 3.07, 95% confidence interval (CI): 1.67-5.65), Log2 sCD14 (aOR: 1.87, 95% CI: 1.04-3.35), Log2 sCD163 (aOR: 3.30, 95% CI: 1.43-7.62) and Log2 I-FABP (aOR: 1.93, 95% CI: 1.08-3.44) but not Log2 CRP (aOR: 0.90, 95% CI: 0.64-1.25). Conclusion: In our case-control study, higher levels of markers of intestinal integrity, monocyte activation, and acute phase proteins were associated increased PTB. Our results identify immune markers that could predict PTB in HIV-infected populations and suggest modulating inflammation and microbial translocation may affect PTB.

834 PLACENTAL EVIDENCE OF MATERNAL VASCULAR MALPERFUSION AMONG HIV-INFECTED WOMEN Rebecca Zash 1 , Morgan Jengela 2 , Drucilla Roberts 3 , Sajini Souda 2 , Modiegi Diseko 4 , Shally Morgan 4 , Gloria Mayondi 4 , Mukendi Kayembe 2 , Lisa Bebell 3 , Mompati O. Mmalane 4 , Max Essex 5 , Shahin Lockman 6 , Joseph Makhema 4 , Roger L. Shapiro 5 1 Beth Israel Deaconess Medical Center, Boston, MA, USA, 2 University of Botswana, Gaborone, Botswana, 3 Massachusetts General Hospital, Boston, MA, USA, 4 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 5 Harvard University, Cambridge, MA, USA, 6 Brigham and Women’s Hospital, Boston, MA, USA Background: HIV-infected women have increased stillbirth, preterm delivery, and small-for-gestational age (SGA) infants, but the mechanism is unknown. Methods: We collected a placentas fromwomen who delivered >=24 weeks gestation at a tertiary hospital in Botswana, including a pre-specified number of HIV+ and HIV- women with stillbirth, preterm delivery and SGA outcomes. Placentas were weighed, examined, fixed in paraffin blocks in Botswana and then sectioned/stained at Mass General Hospital and read by a placental pathologist blinded to exposure status. Maternal vascular malperfusion was defined ≥2 of the following: low placental weight for gestational age, histologic presence of decidual arteriopathy with or without atherosis, distal villous hypoplasia, placental infarcts or placental abruption. Results: From Dec 2015 - Jan 2017, 208 placentas were collected from 101 HIV+ women (92 received antiretroviral treatment [ART]) and 107 HIV- women. These included 18 normal births, 40 stillbirths, 113 preterm births, and 60 SGA; 23 were both preterm and SGA. In women with normal births, placental weight was lower in HIV+ women (median 369g, IQR 357,396) than HIV- women (median 441g, IQR 392,527) (p=0.26). In women with stillbirths, placental weight was lower in HIV+ women (median 194g, IQR 154,245) than HIV- women (median 252g, IQR 189,331) (p=0.04). In women with preterm-SGA, placental weight was lower in HIV+ women (median 249g, IQR 206,309) than HIV- women (median 314g, IQR 272,355) (p=0.09). Maternal vascular malperfusion was

CROI 2018 315