CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: No statistically significant differences were observed across these measures between pregnant and post-partum women treated with efavirenz- or dolutegravir containing regimens. Rates of depression on the EPDS were high, but decreased over the course of time and confirm the need for psychological support after initial HIV diagnosis in pregnancy. Maternal Mental Health and Referral Outcomes Among Women Living With and Without HIV in Botswana Queen M Balina 1 , Sara R. Schenkel 1 , Gosego Masasa 2 , Samuel W. Kgole 2 , Boitshepo Phale 2 , Martha Ngwaca 2 , Kathleen M. Powis 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana Background: Poor mental health among women living with HIV can impact care engagement, treatment adherence, and parenting. We sought to quantify prevalence of depression and anxiety among mothers participating in the Botswana-based FLOURISH study, an ongoing longitudinal observational study following maternal-child pairs, including mothers living with and without HIV and their children, ranging in age from birth to 17 years. Methods: Maternal participants are administered the PHQ-9 and GAD-7 standardized instruments at enrollment to screen for depression and anxiety, respectively. Prevalence of screening positive was compared by HIV status. Unadjusted and adjusted logistic regression models were fit to identify risk factors associated with screening positive. Results: 1087 mothers, including 819 (75.3%) mothers living with HIV (MLHIV), were screened at FLOURISH study entry. Compared to mothers without HIV, MLHIV were older (38.9 years versus 30.9 years; p<0.0001), had lower academic attainment (p<0.0001), lower income (p<0.0001) and reported higher prevalence of severe food insecurity (p=0.001). A total of 104 (9.6%) mothers screened positive for depression including 90 (11.0%) MLHIV and 14 (5.1%) without HIV (p=0.06). Screening positive for moderate to severe depression occurred in 52 (6.3%) MLHIV and 10 (3.7%) without HIV compared to the remainder who screen positive for mild depression.. Prevalence of screening positive for anxiety was 4.8% among MLHIV compared to 6.6% among mothers without HIV (p=0.20). In unadjusted analyses, living with HIV [Odds Ratio (OR) 1.8 (95% Confidence Interval (CI) 1.1, 3.1) p=0.02] and severe household food insecurity [OR 2.3 (95% CI 1.4, 3.9) p=0.002) were significantly associated with screening positive, but no association was noted between maternal age, education level, or household income. In adjusted analysis, severe household food insecurity remained significantly associated with screening positive of depression or anxiety [OR 2.4 (95% CI 1.4, 4.2) p=0.001] but the association between living with HIV and a positive screen was no longer significant after adjusting for age. Conclusion: In this large cohort, mothers living with HIV were more likely to screen positive for depression, but not anxiety. Food insecurity was significantly associated with a positive screening score, highlighting the need for a comprehensive psychosocial support package of care in high burden HIV settings. The figure, table, or graphic for this abstract has been removed. Metabolomic Perturbations of Tryptophan & Arginine Metabolites in the Breast Milk of Women With HIV Nicole H Tobin 1 , Fan Li 1 , Kathie G. Ferbas 1 , John W. Sleasman 2 , Louise Kuhn 3 , Grace M. Aldrovandi 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Duke University, Durham, NC, USA, 3 Columbia University Medical Center, New York, NY, USA Background: Infants born to women with HIV (WWH), but not infected (HIV exposed uninfected, HEU) have two to three times the mortality rate of infants born to women without HIV (WWoH). Tryptophan is an essential amino acid critical for immune development, neurocognitive development, and growth. We investigated the milk metabolome from WWH and WWoH in the pre-ART era to determine if metabolic perturbations may contribute to the impaired immune development of infants born to WWH. Methods: Untargeted metabolomics was performed on 1599 breast milk samples collected longitudinally up to 24 months post-partum from 38 WWoH and 288 WWH with known infant outcomes from a randomized clinical trial conducted in Lusaka, Zambia 2001-2008. The milks of WWH were further separated by infant outcome into 4 groups: HEU infants who survived (n=76) or died (n=78) and infants who became infected either via early mucosal transmission (n=53) or through breast milk (n=81). Linear mixed effects

(minimal), 5-9 (moderate), and >9 (moderate/severe) for anxiety. Unadjusted and adjusted analyses were performed using GEE regression. Results: We evaluated 385 women living with HIV on DTG-based ART and 160 without HIV. Women living with HIV were older than women without HIV (mean 35 vs. 30 years) and were less likely to be from a village (31% vs. 44%) or to have completed senior secondary school or higher education (40% vs. 62%). Overall, 13% of women had scores consistent with moderate/severe depression and 8% with moderate/severe anxiety. Test scores and prevalence of probable depression or anxiety were numerically higher in (but did not differ significantly between) women living with HIV compared with without HIV: probable depression (17% vs. 15%), suicidal ideation (16% vs. 14%), probable anxiety (15% vs. 14%), and referral for mental health services (23% vs. 20%), respectively (Table). After adjustment, differences between women living with and without HIV remained non-statistically significant (Table); severity of depression and anxiety (mild/moderate/severe) also did not differ by HIV status. Conclusion: We observed relatively high overall prevalence of probable depression, anxiety and suicidal ideation. Compared to women without HIV, women living with HIV on DTG-based ART had numerically higher prevalence of depression, anxiety, and suicide ideation, but differences were not statistically significant We referred more than 20% of women for mental health services. Additional mental health services are urgently needed to meet the high demand. Dolutegravir Versus Efavirenz: Depression, Anxiety, and Sleep Disorders in Pregnancy and Postpartum Lena v Wekken-Pas 1 , Sylvia Nassiwa 2 , Thokozile R. Malaba 3 , Mohammed Lamorde 2 , Landon Myer 3 , Catriona Waitt 2 , Helen Reynolds 4 , Saye Khoo 5 , Nengjie He 6 , Elisabeth van Leeuwen 7 , Duolao Wang 4 , David Burger 1 , Angela Colbers 1 , for DolPHIN2 1 Radboud University Medical Center, Nijmegen, Netherlands, 2 Infectious Diseases Institute, Kampala, Uganda, 3 University of Cape Town, Cape Town, South Africa, 4 Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 5 University of Liverpool, Liverpool, United Kingdom, 6 Liverpool School of Tropical Medicine, Liverpool, UK, 7 University of Amsterdam, Amsterdam, Netherlands Background: Both integrase strand transferase-inhibitors and non-nucleoside reverse transcriptase-inhibitors such as dolutegravir and efavirenz, respectively, are known to be effective in pregnancy and post-partum to prevent vertical transmission of HIV and to maintain maternal health. Both drugs have also been associated with neuropsychiatric symptoms such as depression, anxiety and sleep disorders. To what extent these symptoms occur in pregnant and post partum women, however, is not yet known. Methods: This was a secondary analysis of the DolPHIN2 study, a multicentre randomized trial among women presenting late in pregnancy with untreated HIV- who received either a dolutegravir- or an efavirenz- containing regimen. Longitudinal measures of depression, anxiety and sleep quality (Edinburgh Postnatal Depression scale (EPDS)), Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleeping Quality Index (PSQI)) were analysed during pregnancy and up to 48 weeks post-partum. Results: Among 268 women median (IQR) EPDS scores were 8 (3-11) and highest at enrolment at the time of initial HIV diagnosis. In the dolutegravir -and efavirenz arm, respectively, 23.7% and 25.6% had an EPDS score above 9, indicating possible or probable depression. HADS scores were also highest at enrolment and decreased over time. An abnormal HADS score (above 11) was seen at least once during follow up in 42 of patients (15.7%), although no differences were seen between treatment arms. For the anxiety-component 1.9% and 1.5% of the dolutegravir and efavirenz arms, respectively, had a score of 11 or higher. No association was found between EPDS, suicidality (question 10 of EPDS) and HADS scores and the assigned regimen (p = 0.93, 0.97 and 0.18 respectively). Abnormal scores for the depression-component were seen in 3.4% of participants in both treatment arms. Median (IQR) PSQI scores for dolutegravir- and efavirenz were 6 (5-7) and 5 (5-6.5) respectively, p=0.70.

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