CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

of education (86% vs. 77%, p=0.03). PHIV were more likely to use nevirapine (NVP)-based ART (42% vs. 6%, p<0.0001). The prevalence of adverse birth outcomes for PHIV women was 25% SGA, 23% PTD, 2% SB, and 0.8% ND, compared with a prevalence for sexually HIV-infected women of 19% SGA, 21% PTD 3% SB, and 2% ND. Univariate models produced null findings except for SGA (RR=1.33 95% CI:1.07-1.65, p=0.009) and for any adverse outcome (RR=1.23 95% CI:1.08-1.41, p<0.01). Multivariate models produced null findings for all adverse birth outcomes. Use of NVP-based ART accounted for the strongest association with any adverse birth outcome in the multivariate model (Table 1). Conclusion: After adjustment for use of NVP-based ART, a known risk for adverse birth outcomes, there was no difference in adverse birth outcomes between perinatal and sexual HIV transmission. Updating ART regimens may improve birth outcomes for all HIV-infected women.

1 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 2 Northwestern University, Chicago, IL, USA, 3 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA, 4 University of Botswana, Gaborone, Botswana, 5 University of Southern California, Los Angeles, CA, USA, 6 University of Hawaii at Manoa, Honolulu, HI, USA, 7 Albert Einstein College of Medicine, Bronx, NY, USA, 8 ICAP at Columbia University, New York, NY, USA, 9 Harvard University, Boston, MA, USA Background: Prior to a policy of lifetime antiretroviral treatment (ART) for all pregnant women living with HIV (WLHIV), some studies reported lower HIV-exposed uninfected (HEU) infant birth anthropometrics compared to HIV-unexposed uninfected (HUU) infants. We quantified birth anthropometrics by infant HIV exposure status in two Botswana prospective studies, where HEU infants were exposed to either dolutegravir (DTG)- or efavirenz (EFV)-based regimens. Methods: WLHIV and HIV-uninfected (HIV-U) women enrolled in the Tshilo Dikotla study between 16-36 weeks gestation and the Infant Gut Microbiome study between 36 weeks gestation and 3 days post-delivery. All WLHIV received a backbone of tenofovir + emtricitabine, and either DTG or EFV. Birth anthropometrics for singleton infants were abstracted from hospital records. Intergrowth21 was used to derive birth weight-for-age (WAZ) and length-for- age (LAZ) z-scores, adjusting for delivery gestational age and sex. Mean birth WAZ and LAZ was compared between HEU and HUU infants using a Student’s t-test. Among HEU infants, we also compared birth WAZ and LAZ by in utero exposure to either a DTG- vs EFV-based regimen. Results: Data from 463 infants were analyzed, including 275 (59%) HEU infants, with 158 (57%) DTG-exposed and 117 (43%) EFV-exposed. ART exposure from conception occurred among 39 (25%) DTG-exposed and 89 (76%) EFV-exposed infants (p<0.001). WLHIV were older than HIV-uninfected women (29.7 vs 25.3 years; p<0.01). Gestational age at delivery did not differ between HEU and HUU infants (39.0 vs 39.6; p=0.15). Mean birth WAZ and LAZ did not differ by infant HIV exposure status [WAZ: HEU -0.13 (95% Confidence Interval (CI) -0.25, -0.01) vs HUU 0.00 (CI -0.16, +0.16); p=0.20]; [LAZ: HEU +1.07 (95% CI +0.87, +1.26) vs HUU +1.17 (+0.93, +1.41); p=0.51]. Among HEU infants, birth WAZ and LAZ did not differ by DTG vs EFV exposure [WAZ: DTG -0.09 (95% CI -0.26, +0.09) vs EFV -0.18 (95% CI -0.36, 0.00); p=0.45]; [LAZ: DTG +1.16 (95% CI +0.89, +1.43) vs EFV +0.95 (95% CI +0.66, +1.23); p=0.28]. Conclusion: We found no significant difference in birth WAZ or LAZ between HEU and HUU infants or between HEU infants exposed in utero to DTG-based versus EFV-based regimens. Our findings require validation in larger birth cohorts. 752 ADVERSE BIRTH OUTCOMES AMONG PRENATALLY VS SEXUALLY HIV- INFECTED WOMEN IN BOTSWANA Christina Fennell 1 , George R. Seage 1 , Rebecca Zash 2 , Kelesitse Phiri 1 , Modiegi D. Diseko 3 , Gloria K. Mayondi 3 , Shahin Lockman 1 , Tumalano Sekoto 3 , Mompati O. Mmalane 3 , Joseph Makhema 3 , Roger L. Shapiro 1 1 Harvard University, Boston, MA, USA, 2 Beth Israel Deaconess Medical Center, Boston, MA, USA, 3 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana Background: Adverse birth outcomes among perinatally HIV-infected women (PHIV) may be increased compared with sexually HIV-infected women, but comparisons are potentially subject to bias from use of older ART regimens or other factors. The purpose of this study was to compare birth outcomes among (PHIV) and sexually HIV-infected women in a large dataset from Botswana. Methods: Data were compiled from an ongoing birth outcomes surveillance study at eight government delivery sites in Botswana from July 2014 to June 2018. Pregnant women diagnosed with HIV before their 11th birthday were classified as PHIV; all other women were categorized as sexually HIV-infected. Birth outcomes included small for gestational age (SGA) (<10th percentile weight for GA), preterm delivery (PTD) (<37 weeks GA), stillbirth (SB), and neonatal death (ND). Chi-square and Fisher’s exact tests were conducted comparing birth outcomes among all PHIV women with sexually HIV-infected women within the same age range (15-27 years). Crude and adjusted risk ratios (RR) for maternal age, initial ART regimen prescribed or continued during pregnancy, gravida, education, and occupation were determined using log- binomial regressions. Results: Of 22,761 HIV+ women who delivered during the study period, a total of 255 (1%) PHIV women were identified and were compared with 6,773 sexually HIV-infected women in the same age range. The median age of HIV diagnosis was 7 years for PHIV women and 21 years for sexually HIV-infected women. PHIV women were more likely to have a secondary or equivalent level

Poster Abstracts

753 ADVERSE PREGNANCY OUTCOMES IN HIV-POSITIVE PREGNANT WOMEN ON ART IN KENYA Lisa L. Abuogi 1 , Maricianah A. Onono 2 , Anna Helova 3 , Kevin Owuor 2 , Tobias Odwar 2 , Karen Hampanda 1 , Thomas A. Odeny 2 , Elizabeth A. Bukusi 2 , Janet M. Turan 3 1 University of Colorado, Aurora, CO, USA, 2 Kenya Medical Research Institute, Nairobi, Kenya, 3 University of Alabama at Birmingham, Birmingham, AL, USA Background: While antiretroviral treatment (ART) is essential for the elimination of mother-to-child transmission (MTCT) and improved health outcomes for women living with HIV (WLWH) globally, adverse pregnancy outcomes (APO) among pregnant women on life-long ART are a growing concern. Methods: A total of 1225 pregnant WLWH enrolled in the Mother-Infant Visit Adherence and Treatment Engagement (MOTIVATE) study from 24 clinics in a high HIV prevalence region in southwestern Kenya between January 2015 to January 2018 were included. MOTIVATE is a cluster-randomized trial testing the impact of two behavioral interventions (community mentor mothers (CMMs) and text messaging) on retention in care and antiretroviral treatment (ART) adherence among HIV-positive pregnant/postpartumwomen. Women with an APO (miscarriage, stillbirth, neonatal death, infant death, preterm delivery, low birth weight) were compared with women with live birth at least 30 days postpartumwithout APO. Maternal deaths were excluded from analysis. Multivariable logistic regression was conducted including multiple predictors of APO, accounting for clustering by site. Results: Among 1225 HIV-positive pregnant women of median age 30.5 years (IQR 26.2 – 34.2), 440 women (35.9%) experienced an APO, including 333 (27.2%) preterm deliveries, 54 (4.4%) low birthweight infants, and 80 (18.2%) fatal adverse outcomes (including stillbirths, miscarriages, and maternal,

CROI 2019 290