CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Results: 63 HEU and 373 HIV-unexposed children were evaluated at 24 months of age. Mean total MDAT score was 0.2 standard deviations (SD) lower in HEU compared to HIV-unexposed children (90.7 versus 92.7; mean difference -1.8; 95%CI -3.7, 0.1), driven mainly by lower gross motor scores (difference -0.8; 95%CI -1.5, -0.1). MacArthur-Bates CDI vocabulary scores were also 0.2 SD lower in HEU compared to HIV-unexposed children (56.9 versus 61.3 words; mean difference -4.2, 95%CI -8.3, -0.2). There was no evidence of a difference in object permanence or self-control scores between groups (Table). Conclusion: ECD outcomes at 2 years of age differed between HEU and HIV- unexposed children in some but not all measures. There was some evidence that HEU children had lower total developmental scores, including lower language scores as assessed by a tool specifically adapted for Shona-speaking households. However, there was no evidence of differences in object permanence or self-control. Longer-term studies are needed to evaluate whether relatively small differences in motor and cognitive outcomes at age 2 years translate into meaningful differences in school attainment at older ages.

scores (91 vs 86, p<0.01). Mean scores and the proportion with an abnormal score for each of the Bayley-III domains were not significantly different between infants born to women with PHIV vs NPHIV in unadjusted models. After adjustment for maternal age, race/ethnicity, WASI score, CD4 in pregnancy, and presence of mental health condition, as well as infant English monolingual environment and in utero exposure to ≥3 ARV classes, infants of women with PHIV had lower language (91.8 vs 94.8, p=0.04) and motor (93.7 vs 96.8, p=0.03) composite scores but no differences in cognitive composite scores. Conclusion: Cognitive outcomes of infants born to women with PHIV vs NPHIV are reassuring. Differences in language and motor functioning, while of limited clinical significance, highlight the importance of long-termmonitoring of neurodevelopment in children born to PHIV women.

786 NEURODEVELOPMENTAL OUTCOMES FOLLOWING IN UTERO EFAVIRENZ EXPOSURE AMONG HEU CHILDREN Adam R. Cassidy 1 , Paige L. Williams 2 , Jean Leidner 3 , Gloria K. Mayondi 4 , Gbolahan Ajibola 4 , Judith Mabuta 4 , Joseph Makhema 4 , Kathleen M. Powis 5 , Roger L. Shapiro 6 , Betsy Kammerer 1 , Shahin Lockman 7 1 Boston Children’s Hospital, Boston, MA, USA, 2 Harvard University, Boston, MA, USA, 3 Goodtables Data Consulting, Norman, OK, USA, 4 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 5 Massachusetts General Hospital, Boston, MA, USA, 6 Beth Israel Deaconess Medical Center, Boston, MA, USA, 7 Brigham and Women’s Hospital, Boston, MA, USA Background: A large and increasing number of women with HIV infection conceive while taking efavirenz (EFV)-based antiretroviral treatment (ART) globally. Despite concerns regarding potential adverse neurologic outcomes, few studies have evaluated child neurodevelopment following in utero exposure to EFV-based maternal ART. We hypothesized that (a) HEU children with fetal EFV exposure would exhibit worse neurodevelopmental and social-emotional outcomes than HEU children with fetal exposure to non-EFV-based antiretroviral (ARV) regimens, and (b) among EFV-exposed children, initial exposure beginning at conception or during the first trimester would be associated with worse outcomes than exposure beginning later in gestation. Methods: 24-month old HEU children whose mothers took EFV-based ART (EFV-exposed) were recruited fromMay 2016 to May 2017. Their neurodevelopmental outcomes were compared to those from a previously- tested cohort of 24-month old HEU children exposed to non-EFV-based ARVs (non-EFV-exposed). The testing protocol included the Bayley Scales of Infant Development: Third Edition (BSID-III) adapted for use in Botswana; and the Developmental Milestones Checklist (DMC), and Profile of Social Emotional Development (PSED), both developed in Africa. General linear models were used to compare mean outcomes, adjusting for maternal health and child sociodemographic cofounders; mean differences were expressed using Cohen’s d effect sizes. Results: Our analysis included 493 HEU children (126 EFV-exposed, 367 EFV-unexposed). Adjusted mean scores for the EFV-exposed group were lower (worse) than the EFV-unexposed group on the BSID-III Receptive Language scale (adjusted means=21.5 vs 22.5, p = 0.05), DMC Locomotor (30.7 vs 32.0, p<0.01), and Fine Motor scales (17.8 vs 19.2, p<0.01); higher (better) on the DMC Language scale (17.6 vs 16.5, p=0.01); and higher (worse) on the PSED (11.7 vs 9.9, p=0.02). Effect sizes for these differences ranged from 0.24 – 0.50 (see Table 1). Children with fetal EFV exposure during the first trimester (n = 53) had worse scores on the BSID-III Receptive Language scale than children with later gestational exposure (n = 73; EFV mean = 20.7 vs non-EFV mean = 22.2, p=0.02).

Poster Abstracts

785 NEURODEVELOPMENT IN INFANTS OF WOMEN WITH PERINATALLY VS NONPERINATALLY ACQUIRED HIV Jennifer Jao 1 , Deborah Kacanek 2 , Wendy Yu 2 , Paige L. Williams 2 , Kunjal Patel 2 , Sandra Burchett 3 , Gwen Scott 4 , Elaine J. Abrams 5 , Rhoda Sperling 6 , Russell B. Van Dyke 7 , Renee Smith 8 , Kathleen Malee 1 , for the Pediatric HIV/AIDS Cohort Study 1 Northwestern University, Chicago, IL, USA, 2 Harvard University, Boston, MA, USA, 3 Boston Children’s Hospital, Boston, MA, USA, 4 University of Miami, Miami, FL, USA, 5 Columbia University, New York, NY, USA, 6 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 7 Tulane University, Metairie, LA, USA, 8 University of Illinois at Chicago, Chicago, IL, USA Background: The neurocognitive and psychosocial impact of lifelong HIV and antiretroviral therapy (ART) may confer neurodevelopmental (ND) risk on offspring of women with perinatally acquired HIV infection (PHIV). No studies have assessed whether maternal PHIV is associated with early infant ND outcomes. Methods: Using the Bayley Scales of Infant and Toddler Development, 3rd Ed. (Bayley-III), we compared ND outcomes at 1 year of age in HIV-exposed uninfected (HEU) infants born to women with PHIV vs. non-perinatally acquired HIV (NPHIV) enrolled in the Surveillance Monitoring for ART Toxicities (SMARTT) study. Eligible HEU infants included those with valid Bayley-III data at 1 year of age and mothers born after 1982. Cognitive, language, and motor domains were assessed as continuous composite scores. The proportion with a composite score <78 in each domain was also evaluated. Maternal PHIV status was identified by self-report and medical record review. Due to the clustering effect of siblings, linear mixed effects models were fit to estimate the mean difference in Bayley- III scores in each domain, comparing infants of women with PHIV vs. NPHIV, adjusting for potential confounders. Results: 550 WLHIV gave birth to 678 HEU children (125 and 553 born to women with PHIV and NPHIV respectively). Women with PHIV were younger (median age 23 vs 25, p<0.01), more likely to be Hispanic (24% vs 12%, p<0.01), have a CD4 count <200 cells/mm³ (21% vs 10%, p<0.01), and receive ≥3 classes of antiretrovirals (ARVs) in pregnancy (18% vs 3%, p<0.01). In addition, women with PHIV had higher median Wechsler Abbreviated Scale of Intelligence (WASI)

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