CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1250 HIV Status and Other Factors Associated With Infection Complicating Abortion in Botswana Bogadi Loabile 1 , Warren B. Bilker 2 , Khumo Khunou 3 , Ngwao Ngwako 4 , Billy Tsima 3 , Merrian Brooks 2 , Thabo Moloi 3 , Chelsea Morroni 5 , Robert Gross 1 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA, 2 University of Pennsylvania, Philadelphia, PA, USA, 3 University of Botswana, Gaborone, Botswana, 4 University of Pennsylvania in Botswana, Gaborone, Botswana, 5 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana Background: People with HIV (PWH) are equally likely to have aborted pregnancies as people without HIV (PWoH) but may be at risk of worse outcomes. Abortion-related infections are a significant cause of morbidity and mortality in regions with restricted access to elective abortion. We aimed to determine if HIV increased the risk of an abortion-related infection. Methods: We conducted a retrospective chart review of women of all ages, <28 weeks’ gestation, admitted to the gynecology unit at a referral hospital in Gaborone, Botswana, for post-abortion care in 2019. Induced and spontaneous abortions were included. Self-reported HIV status was abstracted from a standardized admission form. The admitting diagnosis, including the presence of an abortion-related infection, was captured from the admitting physician's assessment. Bivariate and multivariate models were used to determine factors associated with an abortion-related infection. Results: We reviewed 847 medical charts. Participants aged between 16 and 45 years. Table 1 describes demographics and medical exposures by the outcome of interest, abortion-related infection. Nine percent (74/847) of women were diagnosed with an abortion-related infection. Thirty-six (17%) PWH were diagnosed with an abortion-related infection compared to 29 (6%) women without HIV and 9 (7%) with unknown HIV status. Mechanical injury on vaginal exam was more common in PWH, with 21(10%) PWH compared to 21 (4%) PWoH (P-value: 0.012) found to have evidence of vaginal trauma. PWH were also more likely to report a history of sexually transmitted infection (STI), with 116 (55%) of PWH compared to 232 (46%) of PWoH reporting a prior diagnosis (P-value: 0.001). In adjusted analysis (adjusted odds ratio [confidence interval]), PWH were 3.91 [2.00-7.76] more likely to be diagnosed with septic abortion than PWoH. Other independent risk factors included vaginal mechanical injury (60.58 [27.98-131.17]), non-infectious chronic co-morbidities (i.e., diabetes, hypertension, seizure disorder) (4.39 [1.91-10.10]), and being a decade younger (2.20 [1.19-4.09]). Conclusions: PWH were at higher risk of an abortion-related infection relative to PWoH. Whether this complication is due to immunocompromise or behavioral characteristics in PWH requires additional investigation. The high rate of infection in those with mechanical injury underscores the importance of reducing unsafe abortion practices in settings with extensive abortion restrictions.

among women living with HIV (WWH) during the COVID pandemic, which is key to understanding reproductive health during co-infections. Methods: From 2021-2023, cross-sectional data were collected from the Study of Treatment and Reproductive Outcomes (STAR) cohort of WWH and women without HIV (WWoH) ages 18-45 years in the southern US. Women completed surveys on history of COVID testing (we defined “self-reported COVID” as any self-report of a positive COVID test), COVID vaccination, IM in the past year (spotting, missed periods, early/late periods), and the Perceived Stress Scale. For the current analysis ( n = 188), women were excluded for conditions or medications known to interfere with menses. Women in Atlanta and Miami had plasma tested for COVID antibodies ( n = 86); in this sub-sample, we defined “COVID infection” as having detectable antibodies to nucleocapsid or self-report of a positive COVID test in any setting. We defined “vaccination” as self-reported vaccination or having detectable antibodies to receptor binding domain (RBD) not explained by COVID infection. We examined IM by vaccination and COVID infection groups stratified by HIV status. Results: Among 188 women, 61% were WWH, 49% had IM, 34% self-reported COVID, and 58% reported vaccination. When assessed via a combination of self-report and antibody tests ( n = 86), 69% had COVID infection, and 62% were vaccinated. IM, COVID infection, and vaccination did not differ by HIV status. Among WWoH ( n = 73), IM was associated with lower age (32 vs. 35, p = 0.04), higher stress (17 vs. 13, p = 0.04), and self-reported COVID (70% of WWoH with self-reported COVID had IM compared to 43% without, p = 0.03), but not with self-reported vaccination, BMI, race, or ethnicity. Among WWoH with antibody testing ( n = 42), 61% with COVID infection (per self-report and antibody testing) had IM compared to 27% without COVID. IM was reported by a similarly low percent of WWoH with neither COVID infection nor vaccination (33%) and only vaccination (25%). Among WWH, neither vaccination nor COVID were associated with IM. Conclusions: IM occurred in half of women during the COVID pandemic regardless of HIV status, with higher rates among WWoH with COVID infection; no association was found between IM and COVID vaccination. Further research is needed to understand mechanisms underlying IM, including stress and infection. 1252 Incidence of Intended & Unintended Pregnancies Among Women With HIV on ART: 5-Year Cohort in Abidjan Prescilia Visi Vumba 1 , Abert Minga 2 , Delphine Gabillard 1 , Thierry Tiendrebeogo 1 , Shino Arikawa 1 , Valerie Journot 1 , Angele Yao 3 , Eugène Messou 2 , Renaud Becquet 1 1 University of Bordeaux, Bordeaux, France, 2 PAC-CI Program, Abidjan, Côte d'Ivoire, 3 Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire Background: The advent of antiretroviral treatment (ART) has led to an increase in the number of women living with HIV (HIV+) expressing interest in becoming pregnant. However, the availability of sexual and reproductive health services to support these women in their maternity plans is constrained in sub-Saharan Africa. This study examined intended and unintended pregnancies among adult HIV+ women of childbearing age followed in a 5-year cohort study in Abidjan, Cote d’Ivoire. Methods: We implemented at 2 HIV-care facilities in Abidjan an interventional non-comparative prospective cohort of adult HIV+ women of childbearing age and on ART for less than 24 months. Participants were followed from 2016 to 2021 and were offered sexual and reproductive health services including a various range of contraceptive methods and systematic 3-monthly pregnancy screening. The incidence of pregnancy was estimated, and following states were identified: not pregnant, intended pregnancy, and unintended pregnancy. The trajectory of each woman who became pregnant at least once was then tracked, and the distribution of these women at a given time was analyzed. A non-homogeneous multi-state model identified factors influencing transitions from not pregnant to intended or unintended pregnancy. Results: The median age of the 524 participants at baseline was 35 years. A total of 208 pregnancies were recorded overall, 36% were intended and 64% were unintended. The incidence of pregnancy was 12.5 per 100 person years. We observed a decrease in the proportion of pregnancies over time, and a significant decrease in the proportion of unintended versus intended pregnancies. Figure 1 shows that economic well-being (poor: HR = 3.57; CI95% = [1.95 - 6.56], medium: HR = 1.96; CI95% = [1.29 - 2.99] vs wealthy), parity over 3 (HR = 3.16; CI95% = [1.34 - 7.46] vs 0), number of induced abortion (1: HR = 1.90, CI95% = [1.11 - 3.27]; ≥2: HR = 1.94, CI95% = [1.09 - 3.45] vs 0), live with partner (HR = 1.59; CI95% = [1.05 - 2.40]) and ART delay at baseline

Poster Abstracts

1251 Irregular Menstruation Among Women Is Associated With COVID-19 Infection, but Not Vaccination Emily M. Cherenack 1 , Suresh Pallikkuth 1 , Patricia Racchamarich 1 , Nicholas F. Fonseca Nogueira 1 , Daniel Westreich 2 , Elizabeth F. Topper 3 , Deborah Konkle Parker 4 , Aadia Rana 5 , Seble Kassaye 6 , Anandi N. Sheth 7 , Deborah L. Jones 1 , Maria L. Alcaide 8 1 University of Miami, Miami, FL, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 The Johns Hopkins University, Baltimore, MD, USA, 4 University of Mississippi Medical Center, Jackson, MS, USA, 5 University of Alabama at Birmingham, Birmingham, AL, USA, 6 Georgetown University, Washington, DC, USA, 7 Emory University, Atlanta, GA, USA, 8 University of Miami Miller, Miami, FL, USA Background: Women reported increased incidence of irregular menstruation (IM) during the COVID-19 (COVID) pandemic. No research has evaluated IM

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