CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: The SEARCH “test and treat” strategy resulted in significantly higher levels of VS among HIV+ pregnant and post-partumwomen compared to a control that followed Option B+, suggesting a positive impact of annual population testing and patient-centered care. Post-partumwomen were as likely to maintain or achieve VS as women who did not experience incident pregnancy in intervention communities.

762 IDENTIFYING WOMEN LIVING WITH PERINATAL HIV INFECTION AT RISK OF POSTPARTUM VIREMIA Brad Karalius 1 , Claire Berman 1 , Deborah Kacanek 1 , Anna-Barbara Moscicki 2 , Mary Paul 3 , Kathleen M. Powis 4 , Katherine Tassiopoulos 1 , Kunjal Patel 1 1 Harvard University, Boston, MA, USA, 2 University of California Los Angeles, Los Angeles, CA, USA, 3 Texas Children’s Hospital, Houston, TX, USA, 4 Massachusetts General Hospital, Boston, MA, USA Background: Previous studies have observed worse postpartum outcomes among women living with perinatal HIV infection (WLPHIV) compared to women who acquired HIV later in life. We characterized postpartum viral load trajectories among WLPHIV and evaluated factors that may identify those at risk for postpartum viremia. Methods: PHACS AMP Up is a longitudinal cohort of young adults aged ≥18 years living with perinatal HIV from 14 sites in the United States and Puerto Rico. Lifetime HIV disease characteristics and pregnancy history were abstracted from clinical charts. Group-based trajectory modeling (GBTM) was used to identify trajectories of viral load in the first year postpartum for all pregnancies that resulted in a live birth. Sociodemographic and clinical factors were compared across identified trajectories using generalized estimating equations (GEE) regression models for nominal multinomial responses. Results: Of 276 WLPHIV in AMP Up, 86 had 124 pregnancies resulting in a live birth. 104/124 (84%) of these pregnancies (among 76 women) had postpartum viral loads available for trajectory analysis. The average age at conception of these pregnancies was 21.2 years and 63%were first pregnancies. 19% of births were preterm and there was one second-generation perinatal HIV transmission. GBTM identified three distinct postpartum viral load trajectories as the optimal fit of the data (Figure). These trajectories were classified as reflecting sustained suppression, rebound viremia, and persistent viremia, with 31 (30%), 55 (52%), and 18 (18%) pregnancies included in each group, respectively; viremia was defined as ≥400 copies/mL. Pregnancies of women with sustained postpartum suppression tended to be conceived at older ages than those with rebound or persistent postpartum viremia (mean: 22.5 vs. 20.8 and 20.2 years respectively). Pre-pregnancy viremia also predicted postpartum viremia: 72% of pregnancies with persistent postpartum viremia had all viral loads ≥400 copies/mL in the one year prior to conception, compared to 36% and 3% of pregnancies with postpartum rebound viremia and sustained suppression, respectively. Conclusion: We observed that only 30% of pregnancies among WLPHIV achieved sustained suppression in the first year postpartum. Pregnancies conceived at younger ages and those with pre-pregnancy viremia tended to predict postpartum rebound or persistent viremia, helping identify potential candidates for postpartum adherence interventions.

Poster Abstracts

761 SEARCH INTERVENTION INCREASES VIRAL SUPPRESSION AMONG PREGNANT & POSTPARTUMWOMEN Jane Kabami 1 , Hachem Saddiki Saddiki 2 , James Ayieko 3 , Dalsone Kwarisiima 1 , Atukunda Mucunguzi 1 , Edwin D. Charlebois 4 , Tamara D. Clark 4 , Elizabeth A. Bukusi 3 , Craig R. Cohen 4 , Philippa Musoke 5 , Maya L. Petersen 6 , Diane V. Havlir 4 , Moses R. Kamya 5 , Laura B. Balzer 2 , Gabriel Chamie 4 1 Infectious Diseases Research Collaboration, Kampala, Uganda, 2 Massachusetts Department of Public Health, Boston, MA, USA, 3 KEMRI–Centre for Global Health Research, Kisumu, Kenya, 4 University of California San Francisco, San Francisco, CA, USA, 5 Makerere University College of Health Sciences, Kampala, Uganda, 6 University of California Berkeley, Berkeley, CA, USA Background: Achieving viral suppression (VS) with antiretroviral therapy (ART) in HIV+ women of child-bearing age is critical to maternal health and reducing mother-to-child transmission. Gains in VS among pregnant and post-partum women of universal “test and treat” approaches above and beyond “Option B+” (ART initiated during pregnancy) are unknown. Methods: The SEARCH trial (NCT:01864603) compared an intervention of annual population testing via multi-disease campaigns and universal ART via patient-centered care to an active control of baseline population testing with ART by country standard, including Option B+, in 32 communities in Kenya and Uganda over 3 years. HIV+ women were asked about current pregnancy and live births over prior year and had viral load measured at baseline and after 3 years in control communities, and annually in intervention communities. Between arms, we compared population-level VS estimates (adjusting for incomplete viral load measurement) among all HIV+ women (15-45 years, including in-migrants) reporting a current pregnancy or live birth in the preceding year. In intervention, we also assessed annual impact of incident pregnancy on maintaining or achieving VS, if suppressed or non-suppressed 1-year prior, respectively, as some prior studies have found increased risk of non-suppression post-partum Results: At trial baseline (2013-14), 92% and 93% of 15-45 year-old women tested for HIV, with HIV prevalence of 12.7% and 12.3%, in intervention and control communities, respectively (Table). Among women reporting a current pregnancy or live birth in prior year, population-level VS estimates were 44% and 50% at baseline, and 82% and 77% (p=0.03) at year 3 in intervention and control, respectively. Among women not reporting pregnancy/live birth, population-level VS was also higher at year 3 in intervention (85%) vs. control (75%; p<0.001). Incident pregnancy did not affect proportion maintaining viral suppression (96% if pregnant vs. 97% if not, RR: 1.0 [95% CI: 0.96-1.03]) or achieving viral suppression (77% vs. 74%, RR: 1.04 [0.95-1.13]) at year 1 in intervention communities.

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