CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Elastic net regression identified pre-pregnancy BMI and complex lipids with polyunsaturated side chains to be positively associated with cord C-peptide in both groups. However, in HEU but not HUU infants, arachidonic acid and microbial derivatives of tyrosine and tryptophan were associated with C-peptide. Conclusion: Compared to HUU, HEU infants manifest with insulin resistance. Differences in cord metabolite, lipid subspecies, & adipokines are significant between HEU and HUU infants, suggesting altered fetal metabolic programming due to in utero HIV exposure.

804 INFECTIOUS MORBIDITY OF BREASTFED, HIV-EXPOSED UNINFECTED INFANTS IN SOUTH AFRICA Stanzi M. Le Roux 1 , Elaine J.Abrams 2 , Kirsty Donald 1 , Kirsty Brittain 1 , Tamsin K. Phillips 1 , Allison Zerbe 2 , David M. Le Roux 1 , 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: Without breastfeeding and maternal antiretroviral therapy (ART), HIV-exposed uninfected (HEU) infants experience greater infectious morbidity than HIV-unexposed (HU) infants. We hypothesized that with universal maternal ART, breastfed HEU and HU infants experience similar morbidity. Methods: We recruited and followed pregnant women through delivery and with breastfeeding infants for ≥12 months. All HIV+women initiated ART in pregnancy. Infection-related hospitalisation data abstracted from routine health records were analysed using incidence rate ratios (IRR) from Poisson regression. Results: Mother-infant pairs (n=410 HU, n=459 HEU; pre-ART median CD4 count, 354 cells/µL; HIV viral load, HIV-VL 4•0 log 10 copies/mL; gestation, 22 weeks) were followed for median 12 months. HEU (vs HU) infants experienced more infection-related hospitalizations between 7 days and 3 months (incidence/100 child-years, cy: 34•2 [95%CI 24•4-47•9] vs 9•8 [95%CI 5•1-18•8]; IRR 3•50 [95%CI 1•64-8•30]), but rates were similar at other ages. Rates for HEU infants with healthier mothers (n=84; ART initiation <24 weeks’ gestation, CD4 count>350 cells/µL, HIV-VL<4•0 log 10 copies/mL: 15•88/100cy [95%CI 5•12- 49•23]) approximated those of HU infants (IRR vs HU, 1•62 [95%CI 0•44-6•00]); HEU infants of mothers with late ART initiation and advanced disease had the highest rates (n=44; ART≥24 weeks’ gestation, CD4 count≤350 cells/µL, HIV-VL≥4•0 log 10 copies/mL: 40•44/100cy [95%CI 15•18-107•74]; IRR vs HU, 4•14 [95%CI 1•27-13•44]). Reduced rates were seen among exclusively breastfed, timely-vaccinated HEU infants (n=165;16•82/100cy [95%CI 5•08-18•78]; IRR vs HU, 1•72 [95%CI 0•53-5•59]). Conclusion: Despite ART in pregnancy, breastfed HEU vs HU infants had transiently increased infectious morbidity risks in early infancy. However, differences were driven by advanced maternal disease with late ART iniation, alongside suboptimal breastfeeding and vaccination. Interventions to increase early maternal HIV diagnosis and ART initiation, optimize vaccination and promote optimal breastfeeding should be prioritize to improve HEU child health.

803 MORE SEVERE DISEASE IN HOSPITALIZED HIV-EXPOSED UNINFECTED VS HIV-UNEXPOSED NEONATES Kim Anderson 1 , Emma Kalk 1 , Hlengiwe Madlala 1 , Dorothy C. Nyemba 1 , Nisha Jacob 1 , Amy L.Slogrove 2 , Mariette Smith 3 , Max Kroon 1 , Michael Harrison 1 , Brian Eley 1 , Andrew Boulle 1 , Landon Myer 1 , Mary-Ann Davies 1 1 University of Cape Town, Cape Town, South Africa, 2 Stellenbosch University, Cape Town, South Africa, 3 Western Cape Provincial Department of Health, Cape Town, South Africa Background: Compared to children HIV unexposed and uninfected (CHUU), children HIV exposed and uninfected (CHEU) may have an increased risk of adverse birth outcomes, morbidity and hospitalization, but there are few insights into patterns of morbidity during the neonatal period. Methods: We followed a prospective cohort of HIV+ and HIV- pregnant women recruited from a large antenatal clinic in Cape Town, South Africa. Their infants (CHEU=457; CHUU=475; n=2 HIV+ neonates excluded) were followed up from delivery. Medical records were reviewed to investigate all admissions during the neonatal period (day 0–28 of life). Infants who were in hospital for routine post-delivery observation were excluded. Results: Rates of neonatal admission were similar between CHEU (59/457, 13%) and CHUU (75/475, 16%) (p=0.210). Most admissions occurred directly after birth (CHEU 88% vs CHUU 85%), and mode of delivery was by caesarean section in 64% CHEU vs 57% CHUU. Infectious causes were identified in 37% CHEU vs 35% CHUU (p=0.099); bloodstream infections accounted for most infectious admissions (34/48; 71%). Neonatal respiratory distress was the most common cause of non-infectious admissions, and did not differ between CHEU and CHUU (32% vs 35% of non-infectious admissions; p=0.20). Very preterm births (<32w) occurred more frequently among CHEU admissions (27% vs 9%; p=0.006) as well as very low birthweight (<1500 g) (36% CHEU vs 16% CHUU; p<0.001). Among those hospitalized, 54% CHEU required admission to an intensive care unit (ICU) vs 28% CHUU. Hospitalized CHEU had a 1.94 times increased risk of ICU admission compared to CHUU (95% CI 1.26–2.98). After adjusting for very preterm delivery, the risk of ICU admission remained higher among CHEU (RR=1.60; 95% CI 1.04–2.47). Conclusion: There were no significant differences in overall hospitalization rates or frequency of infectious events during the neonatal period between CHEU and CHUU. However, hospitalized CHEU had increased risk of very preterm birth and very low birthweight, indicating increased severity of adverse birth outcomes. In addition, and independent of very preterm birth, hospitalized CHEU had higher risk of ICU admission, indicating increased disease severity during the neonatal period.

Poster Abstracts

805 HIV EXPOSURE AND HUMAN MILK OLIGOSACCHARIDES MODULATE THE INFANT GUT MICROBIOTA Sarah L. Brooker 1 , Nicole H. Tobin 1 , Fan Li 1 , Louise Kuhn 2 , Grace M. Aldrovandi 1

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