CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: South African WLH on TLD had lower weight gain during gestation compared to HIV- women despite similar REE and physical activity. Reductions in FFM accrual are similar by duration of TLD exposure but FM accrual appears most restricted in women recently initiated on ART. The long-term consequences of these differences for maternal and child metabolic health require urgent attention.

the Luminex platform. We considered each inflammatory marker at T1 and T3 as a separate exposure of interest. Linear mixed effects models were fit to examine whether each exposure was associated with average PPW and PPW trajectories; linear regression was used for associations with PPW change between T1 and 48 weeks. Results: Median age was 32y (IQR, 29-35), 98% were multigravida, and 49% had a BMI≥30 kg/m 2 . The median weight change between T1 and 48 wks PP was 0.10 kg (IQR -3.50 to 4.50). Sixty-one percent initiated TEE pre-conception; all but three participants had VL <100 copies/mL; 86% had a CD4 count >200 cells/µL at T1. TNFR-1 (0.60 vs 0.73 ng/mL, p=0.018) and IL-6 (1.09 vs 1.53 pg/mL, p=0.054) significantly increased between T1 and T3. Levels of other inflammatory markers did not change significantly between T1 and T3. In models adjusted for age, T1 weight, CD4 count, and weight at 2 wks PP, higher T1 sCD14 levels were associated with higher average weight through 48 wks PP (ß = 0.002, p=0.047), and T3 sCD14 with higher PPW gain (ß = 0.006, p=0.048) (Table). Resistin (ß = 0.644, p=0.024), leptin (ß = 0.329, p=0.036) and TNFR-1 (ß = 9.224, p=0.028) at T3 were associated with higher average PPW, and IL-6 (ß = 2.627, p=0.009) with PPW gain. Conclusion: In this sample of pregnant WLH, we found that sCD14 in early and late pregnancy, as well as resistin, leptin, TNFR-1 and IL-6 in late pregnancy were associated with increased PPW, pointing to potential causal mechanisms with implications for long-term cardiometabolic health in WLH. Changes in Body Composition During Pregnancy in South African Women Living With HIV on ART Hlengiwe P Madlala 1 , Lara Dugas 1 , Jennifer Jao 2 , Elaine J. Abrams 3 , Elton Mukonda 1 , Hayli Geffen 1 , Julia Goedecke 1 , Patrick Catalano 4 , Grace A. McComsey 5 , Allison Zerbe 6 , Justine Legbedze 7 , Landon Myer 1 1 University of Cape Town, Cape Town, South Africa, 2 Northwestern University, Chicago, IL, USA, 3 Columbia University, New York, NY, USA, 4 Tufts University, Boston, MA, USA, 5 University Hospitals Cleveland Medical Center, Cleveland, OH, USA, 6 ICAP at Columbia University, New York, NY, USA, 7 Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA Background: Despite widespread interest in how HIV and antiretroviral therapy (ART) affects weight and body composition there are few data from women living with HIV (WLH), and none from pregnant populations, in sub Saharan Africa. Methods: In the Obesogenic oRigins of maternal and Child metabolic Health Involving Dolutegravir (ORCHID) study, we explored the relationship between HIV and ART duration and changes in body composition [weight, fat mass (FM), fat free mass (FFM)] between ≤18w (T1) and 32-34w (T3) of pregnancy. We enrolled WLH receiving tenofovir/lamivudine/dolutegravir (TLD) and HIV-seronegative (HIV-) women [enrolment age ≥16y and ≤18w gestational age (GA)]. Weight, FM and FFM were measured using air displacement plethysmography adjusted for the increase in hydration constant of FFM at T3; resting energy exposure (REE) was measured using indirect calorimetry; GA was confirmed via ultrasound; physical activity was estimated using the Pregnancy Physical Activity Questionnaire. Linear regression was used to explore the relationship between HIV status and TLD duration (<28d, 28-182d and >182d) with changes in body composition parameters between T1 and T3 after adjusting for potential confounders. Results: Overall 970 women were followed: 376 WLH (80% VL <50 copies/mL; 92% CD4 >200 cells/µL; median duration TLD 126d [IQR, 12-465]) and 594 HIV-. Median age was higher in WLH (30y vs 26y, p<0.01) but WLH and HIV- women were similar with respect to median GA (13w), BMI (29 kg/m 2 ), REE (1543 kcal/d) and total physical activity (189 MET hours/w). At T1, women on TLD>182d were most similar to HIV- women in weight, FM and FFM. Between T1 and T3, WLH experienced significantly smaller increases in weight, FM and FFM compared to HIV- women; for weight and FM these reductions were greatest in WLH on TLD<28d (Table). There were no differences in changes during gestation in REE or physical activity between WLH and HIV- women. Findings persisted in sensitivity analyses restricted to women assessed <14w gestation.

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Association of HIV and Dolutegravir With Changes in Blood Pressure During Pregnancy and Postpartum Landon Myer 1 , Elaine J. Abrams 2 , Mustafa Shuaib 1 , Hlengiwe P. Madlala 1 , Sandisiwe Matyseni 1 , Phindi Zwane 1 , Allison Zerbe 3 , Justine Legbedze 4 , Elton Mukonda 1 , Jennifer Jao 5 1 University of Cape Town, Cape Town, South Africa, 2 Columbia University, New York, NY, USA, 3 ICAP at Columbia University, New York, NY, USA, 4 Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA, 5 Northwestern University, Chicago, IL, USA Background: There is growing interest in whether dolutegravir (DTG) use may be associated with changes in blood pressure (BP) in women living with HIV (WLH) but there are few data from pregnant and postpartum women, in particular with BP measures from early pregnancy, and few comparisons with women testing HIV-. Methods: Within the Obesogenic Origins of Maternal and Child Metabolic Health with Dolutegravir (ORCHID) cohort, we enrolled 1601 women at <18 wks gestational age (GA) in Cape Town, South Africa. Women with prevalent diabetes or hypertension were excluded. All WLH were on tenofovir+lamivudine+DTG (TLD). Women were followed through 6 weeks postpartum with serial, standardised BP measures (three measures of the left arm using an automated, calibrated BP cuff sized to participant BMI) conducted separate from routine care. Analyses examined changes in mean systolic and diastolic BP (sBP and dBP) as well as incident hypertension (BP>140/>90mmHg or initiation of antihypertensive agents), comparing (i) WLH to HIV- controls and (ii) varying durations of TLD use among WLH. Results: Between September 2021 and September 2023, 1601 women were enrolled (633 WLH, 968 HIV-; median (IQR) age 28 years [24-32]; BMI 30 kg/ m 2 [25-35]; GA at enrolment 13 weeks [10-16]; 32% primigravida; 6% current smokers). In WLH median duration of TLD use was 190 days (IQR 11-532) and 30% of women initiated TLD in the preceding month. Mean sBP and dBP in pregnancy were similar throughout pregnancy until 6 weeks postpartum between WLH and HIV- controls (Figure). This absence of any association was not altered by adjustment for maternal age, GA, BMI, smoking or family history (sBP coefficient, -0.39mmHg; 95%CI: -1.35, 0.58; dBP coefficient, 0.13mmHg; 95%CI: -0.59, 0.84). In separate analyses increasing duration of TLD was not associated with changes in sBP or dBP (not shown). Through 6 weeks postpartum 9% of women experienced incident hypertension, with no variation by HIV status (adjusted hazard ratio, 1.27; 95% CI, 0.80, 1.94) or duration of DTG use among WLH. The absence of any association was not altered in subgroups of women with BMI<30kg/m 2 nor in women with their first BP measures <13 weeks' GA. In adjusted models, higher sBP/dBP was associated with increasing age and BMI. Conclusion: While longer durations of follow-up are required to understand the cardiovascular health of WLH on TLD, these reassuring data suggest no association during pregnancy of HIV status or TLD duration with BP or incident hypertension.

Poster Abstracts

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