CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

HDP than those on an EFV-based regimen, both groups had a lower risk than those without HIV. In future analyses it will be important to elucidate the mechanisms responsible for these differences, including the impact of weight and weight gain.

Microsoft Excel-based BIA model was populated with HIV epidemiological data and expenditures from the literature and the DolPHIN trial. These cost projections accounted for a variety of programmatic inputs, disease progression, differences in mortality based on treatment status, subsequent pregnancies, and other factors. The eligible population matched the DolPHIN inclusion criteria, including pregnant women with an adjustment for pre-pregnancy and ART- data. We conservatively assumed a 50-50% market share for the ERS and SOC and an annual discount rate of 3%. Main outcomes of the analysis were incremental budget costs and infections averted over 5 years. Results: Adopting the ERS would lead to a net cost increase of $64 million over the next 5 years, or a net cost increase of $13.8 million per year compared to the SOC. Newly enrolled patients account for $40 million of these marginal costs, while in-system patients account for $24 million. Direct programmatic costs of the ERS only account for 3% of this additional cost, with 97% of the marginal increase coming from the cost of providing ART for women who would otherwise be lost to follow-up. The ERS would avert an additional 6,933 infant infections compared to the SOC, and more than double the probability that women would be retained on ART at the start of subsequent pregnancies (24.94% for ERS vs 10.87% for SOC). Conclusion: Implementing the ERS is likely to produce a significant budget impact to Uganda's Ministry of Health while potentially offering substantial health benefits to people living with HIV. Though costly, the ERS gives an alternative to reducing loss-to-follow-up among marginalized groups. Hypertension in Pregnant Persons by HIV Status and by DTG vs EFV Use in Botswana Denise L Jacobson 1 , Modiegi Diseko 2 , Judith Mabuta 2 , Ellen Caniglia 3 , Kathleen M. Powis 4 , Lynn Yee 5 , Joseph M. Makhema 2 , Shahin Lockman 6 , Roger Shapiro 1 , Rebecca Zash 7 1 Harvard TH Chan School of Public Health, Boston, MA, USA, 2 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 3 University of Pennsylvania, Philadelphia, PA, USA, 4 Massachusetts General Hospital, Boston, MA, USA, 5 Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 6 Brigham and Women's Hospital, Boston, MA, USA, 7 Beth Israel Deaconess Medical Center, Boston, MA, USA Background: In non-pregnant adults, some studies suggest dolutegravir (DTG) is associated with increased risk of hypertension (HTN). Given the serious implications of HTN for pregnancy outcomes, we compared the risk of hypertensive disorders of pregnancy (HDP) among pregnant people on DTG based antiretroviral treatment (ART) to those on efavirenz (EFV)-based ART and to pregnant people without HIV (w/o HIV). Methods: Methods: Among deliveries captured by the Tsepamo Birth Outcomes Surveillance Study (8/2014-8/2022), we included people who presented to antenatal care prior to 20 weeks gestational age (GA) and were either w/o HIV or with HIV and conceived 0.5-5 years after starting DTG- or EFV-based ART. Blood pressures (BP) and medical history of HTN were abstracted from antenatal medical records. Chronic HTN was defined as a pre-pregnancy history of HTN or HTN (systolic BP >140 or diastolic BP >90 mm Hg) before 20 weeks GA. HDP was onset of any HTN (including mild and severe) >20 weeks and predelivery among women without chronic HTN. We determined proportions with chronic HTN and HDP by exposure group, and fit multivariable log-binomial regression models to estimate the adjusted risk ratio (aRR) of HDP in the EFV and w/o HIV groups each compared to the DTG group, adjusted for maternal age, marital status, education, and tertiary delivery site. Results: Of 265,410 deliveries in the study period, we included 127,946; 5,866 conceiving on DTG, 4,771 conceiving on EFV, and 117,309 w/o HIV. Median maternal age was 25 yrs in those w/o HIV and 31 yrs in the DTG and EFV groups (Table 1). The prevalence of chronic HTN was 4.4%, 4.4% and 4.6% and the risk of HDP was 10.2%, 8.1% and 11.7% in the DTG, EFV and w/o HIV groups, respectively. The risk of HDP was 20% lower (aRR=0.80, 95% CI 0.71,0.91) in the EFV group and 20% higher (aRR=1.20, 95% CI 1.10,1.30) in the w/o HIV group, compared to the DTG group. Conclusion: The prevalence of chronic HTN was similar across exposure groups. While pregnant people who conceived on DTG-based ART had a higher risk of

911

Gestational Diabetes in South African Women With HIV on Dolutegravir: Results From the ORCHID Study Jennifer Jao 1 , Elton Mukonda 2 , Landon Myer 2 , Elaine J. Abrams 3 , Hlengiwe Madlala 2 , Jack Hu 2 , Jody Rusch 2 , Jami Josefson 1 , Julia Goedecke 2 , Patrick Catalano 4 1 Northwestern University, Chicago, IL, USA, 2 University of Cape Town, Cape Town, South Africa, 3 ICAP at Columbia University, New York, NY, USA, 4 Tufts University, Boston, MA, USA Background: Few data exist on gestational diabetes (GDM) in Africa, particularly in women with HIV (WWH) receiving dolutegravir-based antiretroviral therapy (ART). This study aimed to assess the association of HIV infection and duration on tenofovir/lamivudine/dolutegravir (TLD) with GDM. Methods: The ORCHID study enrolls WWH initiating/receiving TLD and HIV seronegative (HIV-) women >16 years and <18 weeks gestational age (GA) in South Africa. Pregnant women with diabetes or hypertension are excluded. Participants undergo air displacement plethysmography assessment of body composition and a 75g oral glucose tolerance test at enrollment and 32-34 wks GA. GDM is defined as meeting WHO 2013 criteria or clinician diagnosed GDM. Duration of TLD was categorized as initiating <14 (TLD14) vs 15-90 (TLD15-90) vs >90 (TLD>90) days prior to enrollment. Logistic regression models were fit to assess the association of 1) HIV status and 2) duration of TLD with GDM, adjusting for confounders. Results: 1574 women were included (627 WWH, 947 HIV-); among WWH there were 166 TLD14, 92 TLD15-90, and 369 TLD>90. WWH were older (median 30 vs 26 years) with a lower proportion primigravid (21 vs 40%). At enrollment, median (interquartile range) GA was 13 (10-16) wks, BMI 30 (25-35) kg/m 2 , and fat mass index (FMI) 12.3 (8.8-16.3) kg/m 2 , with no differences between WWH and HIV- women. Among WWH, 93% had CD4 >200 cells/mm 3 and 79% had viral load (VL) <50 copies/mL. Overall, 8.0% of WWH and 8.1% of HIV- women had GDM; adjusted analyses confirmed similar rates of GDM by HIV status. (Table) Of the 127 participants with GDM, 69% were diagnosed at enrollment, 24% at 32-34 wks, and 7.1% by clinician between enrollment and 32-34 wks. Among WWH, the TLD15-90 group had the highest rates of GDM compared to TLD14 and TLD>90 (14 vs 4.8 vs 7.9%, respectively). After adjusting for age, GA at enrollment, education, gravidity, FMI, CD4, and VL, WWH receiving TLD15-90 had higher odds of GDM vs those on TLD14 [adjusted odds ratio (95% confidence interval) = 2.83 (1.01-8.30)]. No differences in GDM risk were observed comparing TLD>90 vs TLD14. Conclusion: WWH and HIV- women have similar rates of GDM in South Africa, consistent with the reported prevalence in sub-Saharan Africa. WWH on TLD for 15-90 days who initiated TLD periconception or in the 1st trimester may be at higher risk for GDM. Future studies are warranted to confirm this finding and assess the potential benefits of screening for GDM at this earlier timepoint in this population.

Poster Abstracts

910

CROI 2024 285