CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

912

Pregnancy History Affects Age-Related Comorbidity Burden in US Women With and Without HIV Lauren F Collins 1 , Cyra C. Mehta 1 , Ava Cox 1 , Qian Yang 1 , Tina Tisdale 1 , Martina Badell 1 , Igho Ofotokun 1 , Daniel Westreich 2 , Adaora Adimora 2 , Seble Kassaye 3 , Elizabeth F. Topper 4 , Deborah Konkle-Parker 5 , Aadia Rana 6 , Maria L. Alcaide 7 , Anandi N. Sheth 1 1 Emory University, Atlanta, GA, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 Georgetown University, Washington, DC, USA, 4 The Johns Hopkins University, Baltimore, MD, USA, 5 University of Mississippi Medical Center, Jackson, MS, USA, 6 University of Alabama at Birmingham, Birmingham, AL, USA, 7 University of Miami, Miami, FL, USA Background: Despite non-AIDS comorbidities (NACM) being more common and occurring earlier in life among women versus men with HIV, evidence is lacking to understand potential drivers of sex differences. We evaluated the effect of reproductive history on NACM development in women. Methods: We performed a cross-sectional analysis of the Study of Treatment And Reproductive outcomes (STAR), a longitudinal cohort of women with and without HIV (WWH; WwoH) aged 18-45 years enrolled in 6 Southern U.S. sites. NACM prevalence and burden (total NACM count of 12 assessed) was determined at STAR enrollment. Pregnancy history was categorized as zero, 1-2, or ≥3 prior pregnancies. Linear regression models evaluated the association of NACM burden with HIV serostatus, age, and pregnancy history. Results: Among 519 women (354 WWH; 165 WwoH), median age was 36 (Q1-Q3 30-41) years, 75% reported Black race, 45% ever smoked; 22%, 32%, and 46% had zero, 1-2, and ≥3 pregnancies, respectively. Among WWH, median CD4 count was 666 (Q1-Q3 448-938) cells/mm 3 and 77% had HIV-1 RNA <200 c/ml. NACM prevalence was (WWH/WwoH): obesity (59%/55%), psychiatric illness (54%/46%), anemia (38%/30%), lung disease (30%/29%), hypertension (25%/26%), bone disease (25%/28%), diabetes (8%/6%), cardiovascular disease (7%/4%), liver disease (7%/1%), dyslipidemia (4%/3%), kidney disease (3%/1%), non-AIDS cancer (1%/1%). Among women with available data for all NACM assessed (n=332), WWH vs WwoH had a mean NACM burden of 2.5 vs 2.4, p=0.24. Among women overall, mean NACM burden increased with age group: 1.9 (18-24y), 2.2 (25-29y), 2.5 (30-34y), 2.7 (35-39y), 2.7 (40-45y) (p-trend=0.002). Among women with zero, 1-2, ≥3 pregnancies, age-adjusted mean NACM burden was 2.4, 2.2, and 2.6 (p-trend=0.20). HIV serostatus did not modify the effect of age and pregnancy history on NACM burden (HIV*age*pregnancy interaction p=0.76). Among women across HIV status, pregnancy history was associated with estimated NACM burden in certain age groups: 18-24y (p-trend>0.99), 25-29y (p-trend=0.03), 30-34y (p-trend=0.11), 35-39y (p-trend=0.21), 40-45y (p-trend=0.71) (Figure). Conclusion: Among reproductive age women in the U.S. South, the burden of 12 NACM was high overall, increased with age, and was associated with pregnancy history in some age groups; further, the distribution of NACM prevalence differed by HIV serostatus. These data may inform the development and timing of NACM screening and prevention strategies to be deployed across the reproductive life course.

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Maternal HIV Is Associated With Lower Risk of Preeclampsia Among Zambian Women Katelyn J Rittenhouse 1 , Margaret Kasaro 2 , M. Bridget Spelke 1 , Yuri Sebastiao 1 , Humphrey Mwape 2 , Kenneth Chanda 3 , Nelly Mandona 2 , Bellington Vwalika 3 , Jeffrey S. Stringer 1 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 University of North Carolina in Zambia, Lusaka, Zambia, 3 University of Zambia, Lusaka, Zambia Background: Preeclampsia (PEC) – an important cause of maternal and fetal morbidity – may be caused by an abnormal maternal immune response to the fetal allograft. We examined the association between HIV infection and PEC in a well-characterized urban population of pregnant women in Zambia. Methods: We combined three contemporaneous studies conducted at two facilities in Lusaka between 2015-2022: the IPOP trial (n=800), VP trial (n=140), and ZAPPS cohort (n=3,239). Each study drew from the same population and shared most protocol elements, including antenatal assessments, visit timing, and a standardized procedure for phenotyping adverse birth outcomes. We defined PEC as new-onset (≥20wks) hypertension (≥140 systolic or ≥90 diastolic) with concurrent proteinuria (≥1+). We defined severe PEC as (a) new onset severe-range BP (≥160 systolic or ≥110 diastolic, (b) eclamptic seizure, or (c) provider-initiated preterm delivery (<37wks) for PEC. Using marginal probabilities from logistic regression, we estimated the crude and adjusted risk of PEC associated with HIV infection. Results: The 4,176 women included in the combined cohort had an average age of 28yr (±6) and average BMI of 26kg/m 2 (±5), with 46% completing ≥12yrs of education and 82% living with a partner or husband. In the cohort, 293 (7.0%) were diagnosed with PEC, including 74 (4.6%) of 1,597 women with HIV and 219 (8.5%) of 2,579 women without HIV. Of women with HIV, 74% were on preconception antiretroviral therapy (ART) and 57% had an undetectable viral load (VL) at study enrollment. In both univariate (RR 0.55; 95%CI 0.42-0.70) and multivariate analyses adjusting for maternal age, BMI, chronic hypertension, nulliparity, and twin gestation (ARR 0.53; 95%CI 0.41-0.69), HIV infection was associated with decreased risk of preeclampsia. This reduced risk persisted when the cohort was stratified by preconception ART exposure, detectable VL at study enrollment, and CD4 count at enrollment. Findings were similar when the more stringent definition of severe PEC was applied (Table). Conclusion: In this large, well-phenotyped pregnancy cohort from Zambia, women with HIV are less likely to have preeclampsia compared to those without infection. Although the association does not appear to be mitigated by maternal disease status, further investigation into whether the relative immune suppression of maternal HIV is protective against preeclampsia is warranted. Pregnancy Inflammatory Markers Predict Postpartum Weight in South African People Living With HIV Hlengiwe P. Madlala 1 , Landon Myer 1 , Hayli Geffen 1 , Jody Rusch 1 , Muki Shey 1 , Demi Meyer 1 , Julia Goedecke 1 , Thokozile R. Malaba 1 , Clive Gray 2 , Marie-Louise Newell 3 , Jennifer Jao 4 1 University of Cape Town, Cape Town, South Africa, 2 Stellenbosch University, Cape Town, South Africa, 3 University of Southampton, Southampton, United Kingdom, 4 Northwestern University, Chicago, IL, USA Background: Postpartum weight (PPW) contributes to long-term obesity, a growing concern in women living with HIV (WLH) characterised by low-grade inflammation. We hypothesised that inflammatory markers in pregnancy may be an early indicator of postpartum (PP) obesity risk in WLH. Methods: The Prematurity Immunology in Mothers and their Infants Study (PIMS) enrolled pregnant PWH in Cape Town. All women were either already on tenofovir+emtricitabine/lamivudine+efavirenz (TEE) pre-conception or initiated at enrolment. We included 57 pregnant PWH who were enrolled at ≤14 weeks (wks) gestational age (GA) as assessed by ultrasonography, with viral load (VL) <200 copies/mL, stored plasma collected at ≤14 wks GA (T1) and 29-36 wks GA (T3), and ≥3 PPW measurements (<2, 10, 24, and 48 wks). Soluble (s) CD14, sCD163, leptin, tumour necrosis factor receptor 1 (TNFR-1), resistin, adiponectin, and interleukin-6 (IL-6) were assayed in duplicate using

Poster Abstracts

914

CROI 2024 286