CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

were randomized to either symptom- or C-reactive protein (CRP)-based TB screening. Screen-positive participants (≥1/4 symptoms or CRP≥5mg/L) underwent confirmatory TB testing. Screen-negative participants initiated 3HP (3-months of weekly isoniazid+rifapentine), unless contraindicated (e.g., pregnant). All women <50 years underwent baseline urine pregnancy testing. For women <50 years, we compared baseline characteristics (including TB screening status, TB prevalence, TPT uptake), by pregnancy status at enrollment and abstracted antenatal characteristics and birth outcomes from medical records for PWWH. Results: Of 1018 women <50 years, 270 (27%) were pregnant at enrollment. Compared to non-pregnant women, PWWH (median gestational age 22.6 weeks, IQR 16.7-28.6) were younger (25 vs. 29 years), had less advanced HIV (CD4 284 vs. 255 cells/µl), higher BMI (25.0 vs. 22.7 m2/kg), and were less likely to screen positive for TB (34 vs. 45%) (p<0.01 for all). Among women who screened-positive, TB prevalence was lower among PWWH than non-pregnant women (4 vs. 10%, p<0.01). Among women who screened-negative, 0/178 (0%) PWWH and 343/376 (91%) non-pregnant women initiated 3HP and 0 PWWH were offered traditional preventive therapy. Birth outcomes were available for 246 (91%) PWWH and included 225 infants from 220 (89%) live births, 4 (2%) stillbirths, and 9 (4%) spontaneous abortions. Of the 225 infants, 5 (2%) were preterm, and 18 (21%) were low birthweight. Conclusions: In our trial, 1 in 4 women initiating ART were pregnant. Although pregnancy is associated with increased TB risk, TB prevalence among PWWH was less than half that of non-pregnant women, suggesting differences in care-seeking behavior and/or TB screening test sensitivity, and PWWH were less likely to receive TPT, highlighting gaps in TPT coverage with novel and traditional regimens. Incidence of Tuberculosis in South African Women Living With HIV During Pregnancy and Postpartum Jasantha Odayar 1 , Mustafa Shuaib 1 , Jennifer Jao 2 , Molebogeng Rangaka 3 , Hlengiwe Madlala 1 , Sandisiwe M. M. Matyesini 1 , Elton Mukonda 1 , Landon Myer 1 , Elaine Abrams 4 1 University of Cape Town, Cape Town, South Africa, 2 Northwestern University, Chicago, IL, USA, 3 University College London, London, UK, 4 Columbia University Irving Medical Center, New York, NY, USA Background: Tuberculosis (TB) causes considerable morbidity and mortality in pregnancy and postpartum, particularly in women living with HIV (WLH), but there are few data from cohorts of women on dolutegravir (DTG). In addition, while risk of active TB generally decreases with increasing body mass, there are few insights into this association during pregnancy and postpartum. Methods: Consecutive WLH and HIV seronegative women (HIV-) aged >18y and <20w gestational age (GA) attending routine antenatal primary care in Cape Town, South Africa were enrolled in the Obesogenic oRigins of maternal and Child metabolic Health Involving Dolutegravir (ORCHID) study. All WLH were on tenofovir+lamivudine+DTG. Body mass index (BMI) was calculated and categorised as underweight (<18.5 kg/m 2 ), normal (18.5–24.9 kg/m 2 ) or overweight/obese (>25 kg/m 2 ). A correction factor was applied to weight based on GA to estimate pre-pregnancy weight. Follow-up through 24m postpartum included assessment of active TB diagnoses and treatment from routine public sector services based on symptom screening +/- bacteriologic confirmation. GA was by ultrasound; TB events were classified as prevalent (already on treatment at conception) or incident (newly diagnosed during pregnancy or postpartum). TB incidence rates (IRs) were calculated and mixed effects Poisson models were used to assess the association between pre-pregnancy BMI and TB IRs. Results: Among 1920 women (mean age 28y, median GA at enrolment 13w), 42% were WLH (median duration on ART 58m, IQR 26–98); among WLH 7%

had a CD4 <200 cells/uL and 89% had a VL <1000 copies/mL. TB prevalence was 0.4% at conception. TB IRs in WLH and HIV- women were 1,658 (95% CI 942–2920) and 99 (95% CI 14–704) per 100,000 person years, respectively (Table). Adjusting for age, HIV status and CD4 count, education and pregnancy status, TB IRs were higher in WLH with CD4 >200 cells/uL (incidence rate ratio [IRR] 5.0; 95% CI 1.1–22.4) and in WLH with CD4<200 cells/uL (IRR 26.9; 95% CI 2.5–293.9) vs HIV- women. TB IRs were significantly increased if pre-pregnancy BMI was <18.5 kg/m 2 vs 18.5–24.9 kg/m 2 (IRR 32.6; 95% CI 2.34-455.2). IRs for pre-pregnancy overweight/obese were higher than for normal BMI women but this was not statistically significant (IRR 2.42; 95% CI 0.43–13.53). Conclusions: TB IRs remained high in WLH despite ART in this setting. Rates appeared higher in underweight vs normal weight women and may also be increased in overweight/obese women however this requires further investigation.

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High Viral Suppression in Pregnant/Postpartum Women With HIV in a Couples-Based Behavioral Trial Karen Hampanda 1 , Lisa Abuogi 2 , Brenda Muluka 3 , Margaret Kasaro 4 , Janet M. Turan 5 , Lynae Darbes 6 , Benjamin H. Chi 4 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 2 University of Colorado Denver, Denver, CO, USA, 3 University of North Carolina in Zambia, Lusaka, Zambia, 4 CIDRZ / University of North Carolina, Chapel Hill, NC, USA, 5 University of Alabama at Birmingham, Birmingham, AL, USA, 6 University of Michigan, Ann Arbor, MI, USA Background: Couples’ relationship dynamics can affect outcomes among pregnant and postpartum women living with HIV (PPWH). We conducted a randomized controlled trial of a couples-based intervention to improve postpartum HIV and maternal and child health (MCH) outcomes in Zambia. Methods: We adapted a couples-based behavioral intervention to improve maternal HIV-related health behaviors by enhancing theoretically-informed relationship skills (e.g., communication, trust, support) through three counseling sessions. We recruited PPWH attending routine antenatal care at a district hospital in Lusaka. PPWH with a willing male partner were enrolled and randomized 1:1 to enhanced standard of care or the intervention. We tested the efficacy of the intervention to improve maternal postpartum viral suppression (<400 copies/ml; primary outcome) and other outcomes (ART adherence; pediatric HIV testing; exclusive breastfeeding). Descriptive statistics and chi squared tests were performed. Results: From 2020 to 2023, we screened 502 PPWH and enrolled 239 eligible couples. Of the 262 ineligible PPWH, 59% did not have a partner willing to participate (n=154). At baseline, 26% of enrolled PPWH reported male controlling behavior; 3% reported intimate partner violence, 14% reported depression symptoms, and 3% reported PTSD symptoms. Among intervention couples, 93% received at least one counseling session and 60% received all three sessions. Overall, 52 couples (22%) were lost to follow up. We found no differences by intervention group in our primary or secondary outcomes. Nearly all PPWH in the control and intervention arms were virally suppressed at baseline (96% and 94%, p=0.6) and 6 months postpartum (99% and 94%, p=0.2). All (100%) PPWH in both groups reported daily ART adherence and pediatric HIV testing. Exclusive breastfeeding was common in the control (96%) and intervention (97%) arms (p=0.5). Conclusions: We observed high rates of baseline and endpoint viral suppression among PPWH enrolled with their male partners in a couple-based intervention trial. Although we did not detect differences between study arms, the positive MCH and HIV outcomes throughout the study were encouraging. Future work should focus on identifying PPWH at-risk or experiencing poor treatment or mental health outcomes, as well as less stable couples affected by HIV, who may require more targeted support.

Poster Abstracts

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CROI 2025 314