CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

youth were matched to each SMARTT participant by age, sex, and race. Modified Poisson regression models were fit for binary outcomes to quantify the prevalence ratio (PR) of each outcome as a function of cohort. Results: The BP outcome analytic sample included 1096 participants (n=304 from SMARTT), the TC and HDL sample 1301 participants (n=385 from SMARTT), and the LDL, TG, and HOMA sample, 271 (n=83 from SMARTT). Overall characteristics of participants were similar between groups in all analytic samples, but SMARTT participants were more likely to report an annual household income <$20,000 in all samples (p<0.01). Among SMARTT participants, >86% in all samples had in utero exposure to zidovudine, stavudine, didanosine, or zalcitabine. After adjusting for confounders, SMARTT youth had higher rates of systolic and diastolic HTN (PR=3.34, 95% Confidence Interval (CI): 2.48, 4.50; PR=2.04, 95%CI: 1.18, 3.52 respectively) but lower rates of insulin resistance (IR) (PR=0.69, 95%CI: 0.55, 0.88) and hypercholesterolemia which trended towards significance (PR=0.68, 95%CI: 0.44, 1.01) (Table). Conclusion: Obese HEU youth appear to be at higher risk for HTN, but lower risk for hypercholesterolemia and IR, compared to a matched obese U.S. population. Further studies are warranted to understand the causes and long-term implications of these findings.

log 10 VCY was associated with higher odds of delay in motor (OR 3.82, 95%CI 1.46;3.27) and language (OR 3.46, 95%CI 1.79;6.71), but not cognitive domains (1.47, 95%CI 0.66; 3.27). Conclusion: HIV viraemia in pregnancy may adversely affect cognitive, motor and language development of HEU infants. Achieving rapid and sustained maternal viral suppression and preventing preterm delivery are critical for promotion of HEU child health.

Poster Abstracts

875 HIV VIRAEMIA IN PREGNANCY AND NEURODEVELOPMENT OF HIV- EXPOSED UNINFECTED CHILDREN Stanzi M. le Roux 1 , Elaine J. Abrams 2 , Kirsty Donald 1 , Kirsty Brittain 1 , Tamsin K. Phillips 1 , Allison Zerbe 2 , Max Kroon 1 , Landon Myer 1 1 University of Cape Town, Cape Town, South Africa, 2 ICAP at Columbia University, New York, NY, USA Background: Maternal HIV viraemia in pregnancy is associated with increased mortality,infectious morbidity and immunological abnormalities among HIV- exposed uninfected (HEU) children, but little is known about the effects on early childhood development Methods: HIV-infected women initiating lifelong ART (TDF+FTC+EFV) were followed through pregnancy and with their breastfed infants to 18 months postpartum for the MCH-ART study. Cognitive, motor and language development (BSID-III) were assessed on a subset of HEU infants at 12 months, [excluding gestational age (GA) at birth<28 weeks, known cerebral palsy, congenital abnormalities or significant prenatal alcohol exposure]. Antenatal intimate partner violence (IPV) and risky drinking were measured with standardized tools. Maternal CD4 cell count (CD4), hemoglobin (Hb) and HIV viral load (VL) were measured at ART initiation; VL was repeated in late pregnancy and close to delivery. Cumulative viraemia in pregnancy was expressed as log 10 VL copies x year/mL (viraemia copy-years, VCY). Relationships between VCY and development were tested with linear (difference in mean composite scores) and logistic (odds of delay, BSID-III composite score<85) regression analyses, adjusting for confounders. Results: Women (median pre-ART log 10 VL 4.06, CD4 349 cells/mm 3 ; 2.4 log 10 VCY) commonly reported adverse social circumstances (29% risky drinking, 20% IPV). Infants’ (n=214; median age 13 months; 53%male; 13% GA<37 weeks) BSID-III scores were inversely correlated with VCY [per log 10 VCY increase: β(95%CI) for cognitive, -1.87(-4.59; 0.84); motor, -2.82(-5.60; -0.03); and language, -3.71(-6.60; -0.83)]. Adjustment for GA strengthened associations across domains [aβ (95%CI) for cognitive, -2.33(-5.05; 0.39); motor, -3.40(-6.16; -0.64); language, -3.74(-6.66; -0.82)]. Further adjustment for IPV, risky drinking, CD4, Hb and breastfeeding attenuated the associations [aβ(95%CI) for cognitive, -1.35(-5.01;2.30); motor, -2.13(-5.85;1.60); and language, -2.54(-6.48;1.39)]. Logistic regression results were largely similar; adjusting for GA, increasing

876 DEVELOPMENTAL OUTCOMES AND ARV EXPOSURE IN HIV-EXPOSED UNINFECTED CHILDREN Micah Piske 1 , Matthew A. Budd 1 , Annie Q. Qiu 2 , Evelyn J. Maan 2 , Laura J. Sauve 2 , John C. Forbes 2 , Ariane Alimenti 2 , Patricia Janssen 1 , Helene C. Cote 1 1 University of British Columbia, Vancouver, BC, Canada, 2 Oak Tree Clinic, Vancouver, BC, Canada Background: Half of all HIV+ adults worldwide are female, and over 1.4 million children are born annually to mothers living with HIV. Globally, an increasing proportion of HEU children are exposed to ARVs in utero. In Canada, over 200 children are born each year to HIV+mothers, most of whom are HIV-Exposed Uninfected (HEU). The long-term effects of exposure to maternal HIV “milieu” and ARVs are not well understood. In this study, we aimed to investigate risks of neurodevelopmental disorders (NDs) among HEU children born in British Columbia (BC), Canada, and examine possible associations with ARV exposure, adjusting also for sociodemographic influences. Methods: Data on 446 HEU children and 1323 HIV-unexposed uninfected (HUU) children (matched ~1:3 for age, sex and geocode) born between 1990-2012 were collected by Population Data BC from provincial data sources: BC Ministry of Health Medical Services Plan (ICD-9 codes), BC Vital Statistics, Perinatal Services BC, and the Oak Tree Clinic, Vancouver, BC. Multivariate logistic regressions were conducted using STATA IC 13. Results: HEUs had a >2x increased risk for autism, disturbance of emotions, hyperkinetic syndrome, and developmental delay (p<0.0001); but not for intellectual disability or epilepsy compared to controls in unadjusted analyses. They also had a 3-fold increased risk of being born preterm, a known risk factor for NDs. After adjusting for follow-up time, sex, maternal substance use, and/or smoking during pregnancy (in children born after April 2000 when these data were collected; HEU N=309, HUU N=917), HEUs persisted in having an increased risk of ND diagnosis compared to controls (OR=1.7; 1.1-2.5; p=0.01). Regardless of ARV exposure type, (i.e. none, treatment with one or multiple drug classes), HEUs had higher odds of any NDs compared to matched HUUs; however, there

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