CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

PLWH not in HP. Odds ratios (OR), 95% confidence intervals (CI), chi-square (Χ2) and Fisher’s exact test were used to assess statistical significance. Results: Of 519 live births to WA PLWH, 292 (56.26%) were included in HP (284 singletons, 8 twins). Among singletons, LBW occurred more frequently among HP (35/284 (12.32%)) compared to WA (59,228/1,173,408 (5.05%); OR 2.64, 95% CI 1.86-3.76). PTB rates did not differ significantly between HP (9.15%) and WA (8.53%; OR 1.08, 95% CI 0.72-1.62). WA rates increased over time for LBW and PTB (Χ2 test for trend P<0.001 for both). HP LBW and PTB time trends were not evaluable due to small sample size. Among all live births including twins, there were 0/292 HIV-1 transmissions among HP (0%, 95% CI 0-1.03%) and 6/244 among PLWH not in HP (2.46%, 95% CI 1.21-3.71%; Fisher’s exact 2-tail P =0.0086). Birth parent HIV diagnosis occurred before or during pregnancy for 5 of 6 affected infants; 4 infants were diagnosed with HIV at ≤ 1 month of age, and 2 diagnosed at > 1 year of age with probable breastfeeding transmission. Conclusions: PLWH receiving prenatal and HIV care in a contemporary HP program had an increased risk of LBW but not PTB compared to WA birth registry data. Perinatal HIV-1 transmission occurred only among PLWH not in HP, suggesting missed prevention opportunities.

and SGA (AOR 0.38, 95% CI 0.23-0.61), and increased the odds of LGA (AOR 4.51, 95% CI 2.70-7.74). Conclusions: These results suggest few meaningful differences in birth outcomes between WLH on TLD and HIV-negative women in this setting where both HIV and obesity are prevalent, while maternal BMI appears to be the major driver of birth outcomes in this cohort.

1001 Impact of Gestational Diabetes on Pregnancy Outcomes in South African Women Living With HIV Elton Mukonda 1 , Jamie E. Meyer 1 , Elaine Abrams 2 , Thokozile R. Malaba 1 , Hayli Geffen 1 , Hlengiwe Madlala 1 , Sandisiwe M. M. Matyesini 1 , Landon Myer 1 , Jennifer Jao 3 1 University of Cape Town, Cape Town, South Africa, 2 Columbia University Irving Medical Center, New York, NY, USA, 3 Northwestern University, Chicago, IL, USA Background: The prevalence of gestational diabetes (GDM) is increasing globally, including in settings where HIV is prevalent. GDM is associated with pregnancy loss and large-for-gestational age (LGA) deliveries but there are no data on whether these associations are altered by maternal HIV and/or antiretroviral therapy. Methods: The ORCHID study enrolled pregnant women with HIV (WLH) receiving tenofovir+lamivudine+dolutegravir and a comparison group of HIV seronegative (HIV-) women (eligibility: age >16y, <18w gestational age (GA) at enrollment, not known with diabetes or hypertension) in Cape Town, South Africa. Pregnancy dating was from research sonography. A 75g oral glucose tolerance test was administered at enrollment and at 32-34 weeks GA; GDM was defined according to WHO 2013 criteria or by clinician diagnosis. In analysis, LGA was based on Intergrowth reference standards. Separate logistic regression models were fit to assess the interaction between GDM and HIV with pregnancy loss (>20w GA) and LGA deliveries, adjusting for known confounders. Results: A total of 1817 women (1044 HIV-; 773 WHIV; mean age 28y; median GA at enrollment, 14 weeks) were included in this analysis. 7.8% of WLH and 9.1% of HIV- women were diagnosed with GDM during the study. Birth outcomes were known for 98% of women and included 3.6% with pregnancy loss and 9% LGA live births. Overall women with GDM had increased odds of pregnancy loss (aOR 2.07, 95% CI: 0.97, 4.04), and LGA (aOR 3.17, 95% CI: 1.96, 5.01) compared to women without GDM. These associations were driven by the outcomes of HIV- women (Table). Among HIV- women, rates of pregnancy loss (7.4% vs 3.2%) and LGA (30% vs 7.4%) were significantly higher in women with GDM compared to women without. In contrast, among WLH rates of pregnancy loss (5% vs 3.6%) and LGA (14% vs 8%) were similar between women with and without GDM. In separate multivariable models testing the interaction between HIV and GDM on birth outcomes (not shown) there was evidence for a weaker association between GDM and LGA in WLH compared to HIV- women (interaction odds ratio, 0.36, p=0.061) but no such evidence involving pregnancy loss (interaction odds ratio, 0.59, p=0.5). Conclusions: These novel findings suggest that maternal HIV infection may attenuate the known effects of GDM on LGA deliveries. Further research is required to understand what mechanisms may drive such an attenuation, and more generally to the long-term implications of GDM diagnoses for WLH and their infants.

Poster Abstracts

1000 Impact of TLD on Birth Outcomes in South African Women: The ORCHID Cohort Jamie E. Meyer 1 , Thokozile R. Malaba 1 , Hayli Geffen 1 , Hlengiwe Madlala 1 , Sandisiwe M. M. Matyesini 1 , Elton Mukonda 1 , Jennifer Jao 2 , Elaine Abrams 3 , Landon Myer 1 1 University of Cape Town, Cape Town, South Africa, 2 Northwestern University, Chicago, IL, USA, 3 Columbia University Irving Medical Center, New York, NY, USA Background: The global shift to tenofovir+lamivudine+dolutegravir (TLD) has improved viral suppression in women living with HIV (WLH) in pregnancy but there are limited data on birth outcomes with TLD use. In addition, despite increases in obesity in settings where HIV is prevalent, little is known about how body composition may impact associations between HIV/TLD and birth outcomes. Methods: We enrolled WLH on TLD and a comparison group of HIV negative women seeking antenatal care at primary health facilities in Cape Town. Gestational age (GA) was via research ultrasound; behavioural and demographic data were from questionnaires; anthropometry was through clinical examination. Birth outcome data abstracted from medical records, including pregnancy loss (miscarriage and stillbirth), prematurity (<37w GA), low birthweight (LBW) (<2500g) and size for GA [including small- (SGA) and large-for-GA (LGA) from Intergrowth estimates]. Logistic regression models assessed the association between HIV/TLD and birth outcomes adjusting for maternal age, BMI, alcohol use and education; results are reported as adjusted odds ratios (AOR). Results: We followed 1908 women (804 WLH, 1104 HIV-; mean age 28y, median GA at enrollment, 14w; median BMI at enrollment, 31kg/m 2 [IQR, 25-35]. Birth outcomes were known for 1869 women (98%) including 65 miscarriages (3.4%), 35 stillbirths (1.9%) and 1769 live births (1735 singletons). Overall rates of prematurity, LBW, SGA and LGA were 9.4%, 12%, 13% and 12%, respectively, and did not differ between WLH and HIV- women (Figure 1). BMI did not affect the association between HIV/TLD and any birth outcome. Independent of HIV/ TLD, higher BMI was associated with reductions in prematurity, LBW and SGA. For example, compared to women with normal BMI, women with class 1 obesity (BMI 30-35) experienced decreased odds of prematurity (AOR 0.59, 95% CI 0.36 0.96), LBW (AOR 0.49, 0.31-0.77), and SGA (AOR 0.52, 95% CI 0.33-0.80); Obesity classes 2&3 (BMI >35) decreased the odds of LBW (AOR 0.57, 95% CI 0.37-0.88),

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