CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

were not statistically significant in multivariate analysis (RR 1.27, 95% CI 0.98-1.63, reference category: consistent normal). Among HIV+ women, more women initiating ART in pregnancy were in the abnormal trajectory group than those initiating ART preconception (5% vs 2%), however association was observed (RR2.40, 0.94-6.15). Older (RR1.52, 1.11-2.10) and obese (RR2.06, 1.31-3.25) women were at increased risk of being in the high normal group. In multivariable analyses, low normal trajectory (RR0.59, 0.41-0.85) was associated with decreased risk of PTD, while high normal (RR1.47, 1.11-1.94) and abnormal trajectories (RR3.18, 2.32-4.47) were associated with increased risk of PTD, and abnormal with increased risk of LBW infants (RR3.25, 2.18-4.87). Conclusion: We identified pregnant women with distinct antenatal BP trajectories, which were not associated with HIV/ART status. Further work is required to inform understanding of different BP trajectories in pregnancy, particularly in high HIV prevalent settings.

to 4.80) than in Uganda (0.75 kg; 95% CI -1.48 to 2.97; p for interaction=0.82). Similar findings were observed for BMI throughout. Conclusion: These randomised data show no differences in PP weight changes between DTG and EFV in women initiating ART late in pregnancy. Substantial PP weight gain among SA women points to potential heterogeneity across populations that requires further investigation. 772 DOLUTEGRAVIR USE IS ASSOCIATED WITH HIGHER POSTPARTUM WEIGHT COMPARED TO EFAVIRENZ Jennifer Jao 1 , Shan Sun 2 , Justine Legbedze 2 , Denise Jacobson 3 , Keolebogile N. Mmasa 4 , Samuel W. Kgole 4 , Gosego Masasa 4 , Joseph Makhema 4 , Sikhulile Moyo 4 , Mompati O. Mmalane 4 , Francis Banda 4 , Bornaparte Nkomo 5 , Mariana Gerschenson 6 , Elaine J.Abrams 7 , Kathleen M. Powis 3 1 Northwestern University, Chicago, IL, USA, 2 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA, 4 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 5 Botswana Ministry of Health, Gaborone, Botswana, 6 University of Hawaii, Honolulu, HI, USA, 7 ICAP at Columbia University, New York, NY, USA Background: Postpartumweight retention impacts cardiometabolic risk. Recent studies show higher weight gain with dolutegravir (DTG)-based antiretroviral therapy (ART) compared to other ART. We assessed the association of DTG with postpartumweight over time in women with HIV (WHIV) in Botswana using comparator groups of women on efavirenz (EFV) and HIV- negative (HIV-) women. Methods: The Tshilo Dikotla study enrolled pregnant HIV- women and WHIV on either tenofovir (TDF)/emtricitabine or lamivudine (XTC)/DTG or TDF/XTC/ EFV initiated during or before pregnancy. This analysis included women with weight measurements 1 to 18 months postpartum. Mixed models were fit to assess the association between HIV/ART status and postpartumweight over time, adjusting for confounders. Interaction terms between time and HIV/ART group were evaluated to assess for differences in weight trajectories. Subgroup analysis was performed among WHIV to further assess the association of DTG vs EFV and postpartumweight, adjusting for HIV specific factors. Results: Of 406 women, 170 received DTG and 114 EFV. Women on DTG or EFV were older than HIV- women (median age 28 vs 33 vs 25 years respectively, p<0.01), and fewer had a college education (13.5% vs 4.4% vs 29.5% respectively, p<0.01). Average weight gain per week (wk) between 2nd and 3rd trimester was highest in HIV- women (0.3 vs 0.2 for DTG vs 0.1 kg/wk for EFV, p<0.01) as was breastfeeding duration (35.7 vs. 19.0 for DTG vs. 22.6 wks for EFV, p<0.01). No differences in income, gestational diabetes (GDM), gestational age at delivery, or BMI at 1 month postpartumwere noted across groups. Among WHIV, no differences in CD4 or log viral load at enrollment were noted between ART group; more women on EFV were on their ART at conception (86% vs. 35.3%, p<0.01). Compared to HIV- women, WHIV on DTG had similar postpartumweight through 18 months but were on average 5 kg heavier postpartum than WHIV on EFV (β=5.0, p<0.01) after adjusting for age, GDM, breastfeeding duration, and weight gain between 2nd and 3rd trimester. (Fig) No differences in slope trajectories were noted between groups. This association persisted in subgroup analysis of WHIV even after further adjusting for CD4, viral load, and ART at conception (β=2.4 for DTG vs. EFV, p=0.04). Conclusion: WHIV on DTG have persistently higher weight through 18 months postpartum than those on EFV in Botswana but similar weight to HIV- women. Further studies to assess mechanisms of postpartumweight retention are needed.

Poster Abstracts

771 POSTPARTUMWEIGHT CHANGES IN WOMEN INITIATING DTG VS EFV IN PREGNANCY: DOLPHIN-2 Thokozile R. Malaba 1 , Tao Chen 2 , Kenneth Kintu 3 , Christiana Papamichael 2 , Helen Reynolds 4 , Jesca Nakibuka 3 , Catriona Waitt 4 , Eva Maria Hodel 4 , Angela Colbers 5 , Catherine Orrell 6 , Duolao Wang 2 , Mohammed Lamorde 3 , Saye Khoo 4 , Landon Myer 1 , for the DolPHIN-2 Trial Team 1 University of Cape Town, Cape Town, South Africa, 2 Liverpool School of Tropical Medicine, Liverpool, UK, 3 Makerere University, Kampala, Uganda, 4 University of Liverpool, Liverpool, UK, 5 Radboud University Medical Center, Nijmegen, Netherlands, 6 Desmond Tutu HIV Foundation, Cape Town, South Africa Background: There are growing concerns about weight gain with dolutegravir (DTG) use, with some suggestion of heterogeneity of effects across populations especially among women. However there are no data from pregnancy and the postpartum (PP) period. Methods: DolPHIN-2 (NCT03249181) is an open label trial randomising (1:1) pregnant women from Uganda and South Africa (SA) initiating ART from 28w gestation to DTG vs efavirenz (EFV) plus 2 NRTIs. Maternal weights were measured using standardized procedures at enrolment, <14 days of delivery and at 6, 12, 24 and 48 weeks PP. For this secondary analysis we examined changes in PP weight and body mass index (BMI) between study arms. Results: Enrolment took place between Jan and Aug 2018, and follow-up data were censored Sept 2019; 230 women (mean age, 28y) were included with median follow-up of 60 months. At enrolment (median gestation, 31w) the mean weight and BMI was 74 kg and 28 kg/m 2 , respectively, with no differences between trial arms but higher third trimester weight in SA (mean, 81 kg) versus Ugandan (mean, 68 kg) sites. 73%, 61% and 3% of women reported breastfeeding the infant at 12, 24 and 48w PP, respectively, with no differences by arm. Across both arms and sites, mean change in weight from enrolment to 6w PP was -5.9 kg, with mean weight approximately constant from 6 to 48w PP. However this masked notable inter-site differences. In Uganda, there was a small non-significant decrease in mean weight from 6 to 48w PP that was more marked in the EFV arm (DTG: 63.6 to 63.2 kg; EFV: 60.6 to 59.8 kg; p=0.28). In SA, there was a notable but non-significant increase in mean weight over the same period that was more marked in the DTG arm (DTG: 76.1 to 78.3 kg; EFV: 73.0 to 73.7 kg; p=0.33). After adjusting for site and enrolment weight, the overall mean difference in weight change, 48w-6w PP for DTG-EFV, was 1.00 kg (95% CI -0.98 to 2.97; p=0.32). This difference was larger in SA (1.30 kg; 95% CI -2.21

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