CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Town. Gestational age (GA) was estimated from ultrasound and BP from automated monitors. BP was categorized as normal (<120/80mmHg), elevated (120–129/ <80), stage 1 (>130–139 /or 80–89) or stage 2 hypertension (>140 / or >90). Multivariable modified Poisson regression was used to estimate associations between high (elevated or higher) versus normal BP and HIV status, as well as birth outcomes. We explored modification by HIV status for associations between BP and adverse birth outcomes. We addressed missing data with multiple imputation (n=50 imputations). Results: In 1116 women (HIV+ 53%) with singleton live births (median gestation at 1st ANC, 20 weeks), 48% presented with high BP (53% HIV+ vs. 43% HIV-) at 1st ANC. HIV+ women were more likely to have high BP (RR 1.24; 95%CI 1.04-1.49), controlling for estimated pre-pregnancy body mass index (BMI), maternal age, gravidity, socioeconomic status, alcohol use and education. Overall 12% of infants were preterm (<37 weeks’ gestation), 12%were low birthweight (LBW, <2500g), and 11%were small-for-GA (SGA, <10th percentile for GA). Compared to HIV- women, HIV+ women had more SGA (12% vs. 9%) and LBW (14% vs. 10%) infants, and a similar proportion of preterm births (13% vs. 12%). In multivariable analyses, there was no evidence that high BP increased the risk of preterm birth (RR 1.17, 95% CI 0.83-1.66), LBW (RR 1.14, 95% CI 0.82-1.57) or SGA (RR 1.00, 0.70-1.41), overall or when stratified by HIV status (Table). There was a trend towards high BP increasing the risk of preterm birth (RR 1.43 95% CI 0.85-2.38) and LBW (RR 1.30, 95% CI 0.83-2.04) in HIV- women, but not HIV+ women. Conclusion: In this setting nearly half of all women had high BP at 1st ANC. HIV+ women initiating ART were more likely to have high BP, compared with HIV- women. There was no strong evidence that high BP increased the risk of LBW, SGA or preterm birth overall, but results differed somewhat by HIV status. The high prevalence of high BP in pregnancy, particularly in HIV+ women, requires further investigation. 770 BLOOD PRESSURE TRAJECTORIES AND ASSOCIATED FACTORS IN PREGNANT HIV– AND HIV+WOMEN Thokozile R. Malaba 1 , Annibale Cois 2 , Hlengiwe P. Madlala 1 , Mushi Matjila 1 , Landon Myer 1 , Marie-Louise Newell 3 1 University of Cape Town, Cape Town, South Africa, 2 South African Medical Research Council, Cape Town, South Africa, 3 University of Southampton, Southampton, UK Background: Blood pressure (BP) levels are associated with maternal and fetal outcomes. While associations between HIV/ART and BP have been suggested, little is known about BP trajectories across gestation and their association with pregnancy outcome. Methods: We recruited HIV+ and HIV- women at first antenatal visit at a large primary care facility in Cape Town, South Africa. HIV+ women, predominately on TDF+XTC+EFV regimen, initiated either pre-conception or during pregnancy. Automated BP measurements were used and a combination of ultrasound, last menstrual period and clinical exam for pregnancy dating. Group-based trajectory analysis identified distinct joint systolic and diastolic BP trajectory groups among women with ≥3 antenatal BP measurements. Multinomial regression assessed BP trajectory group associations with HIV/ART status and modified Poisson regression to determine preterm delivery (PTD) and low birthweight (LBW). Results: Of 1583 women (median age 28y; median gestation at 1st ANC 18w), 37%were HIV+, of whom 54% initiated ART pre-conception (n=306) and 46% during pregnancy (n=265). We identified 7 systolic and diastolic joint trajectory groups combinations based on Bayesian information criterion, then classified as consistent normal (50%), low normal (25%), high normal (20%), and increasing abnormal 5%) (Figure 1). The proportion of women in the low normal group was higher among HIV+ than among HIV- women (28% vs. 23%), but differences

University, Kampala, Uganda, 4 Baylor College of Medicine Children's Foundation, Kampala, Uganda Background: Antiretroviral therapy (ART) in persons living with HIV (PWH) is associated with bone loss and increased risk of fracture, but data are limited in pregnant and lactating women when physiological bone mobilisation is also occurring. This research investigated changes in areal bone mineral density (aBMD) in breastfeeding HIV+ve Ugandan women initiated on lifelong ART in pregnancy compared to HIV-negative (HIV-ve) counterparts. Methods: Two groups of pregnant Ugandan mothers planning to breastfeed, 95 HIV+ve (on Option B+ tripple ART [TDF-3TC-EFV], previously ART naïve) and 96 HIV-ve took part. Measurements were made postpartum at 2 (L02), 14 (L14), and 26 (L26) weeks of lactation, and at 14 weeks post-lactation when neither pregnant nor lactating (NPNL). Lumbar spine (LS), total hip (TH), femoral neck (FN) and whole body-less-head (WBLH) areal bone mineral density (aBMD) was measured by DXA. Results: Median age was 24.5 (IQR 21.1, 26.9) yrs. HIV+ve women had lower body weight and a shorter duration of breast feeding (47.8±13.4 vs 65.6±18.1 weeks, p<0.05). Both groups experienced lactational bone mobilisation but HIV+ve women had greater decreases in TH, FN and WBLH aBMD during lactation, and a trend towards a smaller reduction in LS aBMD at L14. Both groups had recovered LS aBMD by NPNL. Hip and WBLH aBMD had returned to L02 values in HIV-ve women but not in HIV+ve (Figure 1). Adjusting for parity, age, body size, breastfeeding practices, duration of breastfeeding, use of depo-provera, resumption of menses, and other potential confounders did not attenuate the results. Conclusion: These data show accentuated mobilisation of hip and WBLH bone mineral during lactation, and slower skeletal recovery post-lactation in HIV+ve Ugandan women initiated on lifelong ART (TDF-based) in pregnancy, compared to HIV-ve women. Studies are ongoing to understand the mechanisms and long term consequences for bone health and growth of the child, to inform interventions aimed at reducing bone loss in pregnant and lactating HIV+ve women on ART.

Poster Abstracts

769 HIGH BLOOD PRESSURE AND ADVERSE BIRTH OUTCOMES IN HIV+ AND HIV– SOUTH AFRICAN WOMEN Angela Bengtson 1 , Stanzi M. le Roux 2 , Tamsin K. Phillips 2 , Kirsty Brittain 2 , Allison Zerbe 3 , Thoko Malaba 2 , Greg Petro 2 , Hlengiwe Madlala 2 , Elaine J. Abrams 3 , Landon Myer 2 1 Brown University, Providence, RI, USA, 2 University of Cape Town, Cape Town, South Africa, 3 Columbia University, New York, NY, USA Background: HIV+ women on ART are at increased risk of some adverse birth outcomes. Both HIV and ART may increase the risk of high blood pressure (BP) outside of pregnancy, but little is known about the prevalence and impact of high BP in pregnancy among HIV+ women. Methods: We followed a cohort of HIV- and HIV+ pregnant women initiating TDF+XTC+EFV from first antenatal care visit (ANC) through delivery in Cape

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