CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

918

DTG Versus EFV Initiation in Pregnancy Is Not Associated With Postpartum Blood Pressure Thokozile R Malaba 1 , Sylvia Nassiwa 2 , Nengjie He 3 , Helen Reynolds 4 , Jim Read 3 , Lucy Read 3 , Catherine Orrell 5 , Angela Colbers 6 , Catriona Waitt 2 , Mohammed Lamorde 2 , Saye Khoo 4 , Duolao Wang 3 , Landon Myer 1 , for the DolPHIN-2 Study Group 1 University of Cape Town, Cape Town, South Africa, 2 Infectious Disease Institute, Kampala, Uganda, 3 Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 4 University of Liverpool, Liverpool, United Kingdom, 5 Desmond Tutu HIV Foundation, Cape Town, South Africa, 6 Radboud University Medical Center, Nijmegen, Netherlands Background: Several studies in non-pregnant adults have suggested increases in blood pressure (BP) associated with dolutegravir (DTG) use, however findings are mixed. There are notably few data from (i) sub-Saharan Africa and (ii) pregnant and postpartum women living with HIV (PLH). Methods: We compared BP in PLH initiating DTG- versus Efavirenz-(EFV-) containing regimens initiated during pregnancy in a secondary analysis of the DolPHIN-2 trial (NCT03249181). At sites in Uganda and South Africa, PLH initiating ART ≥28w gestation were randomly assigned tenofovir+lamivudine/ emtricitabine and either DTG or Efavirenz (EFV) as first-line therapy. PLH were followed with 8 study visits through 72 weeks postpartum including standardised anthropometric and BP assessments including sized cuffs. Given physiologic changes in BP during the perinatal period, analyses focused on systolic (sBP) and diastolic BP (dBP) at 24, 48 and 72 weeks postpartum in PLH assigned to DTG vs EFV using mixed effects linear models adjusted for age, BMI, site, and enrolment BP; temporal changes were evaluated using time interactions in separate models. In addition, we examined the risk of incident hypertension (BP>140/>90) among those with BP<140/<90 at enrolment and 6 weeks postpartum. Results: Overall 268 women were enrolled (median age 28 years; median gestation 31 weeks; median BMI 28kg/m 2 ). Participants in South Africa had consistently higher BMI, sBP and dBP compared to those in Uganda at enrolment and throughout follow-up. However after accounting for site and baseline values there were no associations observed between DTG use and sBP (beta=2.2mmHg; 95% CI -0.6 to 5.0), dBP (beta=1.54mmHg; 95% CI: -0.9 to 4.0) or weight (beta=0.7kg; 95% CI -0.9 to 2.3) through 72w postpartum. Four participants had hypertension detected at enrolment; during follow-up 8 participants switched treatment assignment, none related to blood pressure or weight gain. There was no association between DTG versus EFV and incident hypertension at any time point. Conclusion: These reassuring RCT data suggest that after adjustment for important pre-treatment covariates there was no association between DTG vs EFV initiated late in pregnancy and BP through 18 months postpartum. There is ongoing need for attention to the long-term cardiometabolic effects of DTG use in PLH.

917

High Proportions of Adverse Births in Women With HIV and Non Communicable Disease Comorbidities Amohelang Lehloa , Emma Kalk, Mary-Ann Davies, Dorothy Nyemba, Ushma Mehta, Thokozile R. Malaba, Gregory Petro, Andrew Boulle, Landon Myer, Hlengiwe P. Madlala University of Cape Town, Cape Town, South Africa Background: HIV/antiretroviral therapy (ART) and non-communicable diseases (NCDs) like hypertension, diabetes and obesity are independently implicated in poor pregnancy outcomes. However, there is limited data on the interplay of HIV/ART and these NCDs, and associations with adverse birth outcomes in South African women. Methods: In a retrospective study in an urban primary care antenatal care facility (ANC) in Cape Town, South Africa, 470 women living with HIV (WLH) and 505 without HIV (HIV-) (≥18 years) were enrolled from the first ANC visit between 2017 and 2019 and followed through to delivery. We examined HIV, hypertension (HPT), diabetes mellitus (DM) alone and HIV with obesity, hypertension, and diabetes comorbidity (irrespective of chronicity) and the following outcomes: preterm delivery (PTD <37 gestational weeks), low birthweight (LBW <2500g), high birthweight (HBW ≥4000g) (abstracted from medical records) and small for gestational age (SGA <10 percentile), large for gestational age (LGA >90th percentile) (generated using the INTERGROWTH tool). Differences in proportions of adverse birth outcomes between exposure groups were tested with Chi-squared tests among live singleton births. Results: In this study, median age was 29y (IQR,25-33) and 21% of women were primigravid. Additionally, 47% were obese (BMI≥30 kg/m 2 ), 8% hypertensive and 2% diabetic. Overall, 10% of infants were PTD, 11% LBW, 4% HBW, 10% SGA and 10% LGA. Women with HPT only had 41% PTD, 35% LBW and 29% SGA. Those with obesity only had 4% PTD, 5% LBW, 6% HBW, 5% SGA and 17% LGA. Excluding all NCDs, WLV had 11% PTD, 14% LBW, 3% HBW, 14% SGA and 7% LGA. WLH with obesity had higher LGA (12 vs 7%, p <0.01) and HBW (7 vs 3%, p <0.01) but lower PTD (6 vs 11%, p <0.01), LBW (7 vs 14%, p <0.01) and SGA (5 vs 14%, p <0.01) compared to WLH only. WLH with hypertension co-morbidity had higher PTD (22 vs 11%, p = 0.01), LBW (22 vs 14%, p = 0.03) and SGA (22 vs 14%, p = 0.03) compared to WLH only. Further, WLH with both obesity and HPT had higher LBW (27 vs 11%, p = 0.04) and LBW (19 vs 14%, p = 0.03) compared to WLH only. DM only coexisted with other co-morbidities and not HIV. Conclusion: WLH and an NCD co-morbidity had a higher proportion of some adverse birth outcomes compared to WLH only. Integration of NCD management interventions with ANC services is essential to avert excess adverse outcomes in high HIV burden settings.

Poster Abstracts

CROI 2024 288