CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

793 GROWTH PATTERNS IN CHILDREN OF WOMEN WITH PERINATALLY VS NON-PERINATALLY ACQUIRED HIV Wendy Yu 1 , Denise Jacobson 1 , Paige L. Williams 1 , Kunjal Patel 1 , Russell B. Van Dyke 2 , Linda A. DiMeglio 3 , Mitchell Geffner 4 , Deborah Kacanek 1 , Jennifer Jao 5 , for the Pediatric HIV/AIDS Cohort Study (PHACS) 1 Harvard University, Boston, MA, USA, 2 Tulane University, Metairie, LA, USA, 3 Indiana University, Indianapolis, IN, USA, 4 University of Southern California, Los Angeles, CA, USA, 5 Northwestern University, Chicago, IL, USA Background: Increasing numbers of women with perinatally acquired HIV (PHIV) are reaching reproductive age and having children. Few studies have evaluated the long-term growth of HIV-exposed uninfected (HEU) children born to these women, which may vary by race and sex. Methods: We compared growth trajectories from birth to age 7 years (yrs) in HEU infants born to women with PHIV vs non-perinatally acquired HIV (NPHIV) in the Surveillance Monitoring for ART Toxicities (SMARTT) study, a U.S.-based cohort study enrolling since April 2007. Infants of women born after 1982 were eligible. Z-scores were calculated using U.S. growth references for weight (WTZ) and height (HTZ) from birth, weight-for-length (WLZ) up to 36 months (mos), and body mass index-for-age (BMIZ) from 36 mos onward. Mixed effects models were fit stratified by race and sex to assess differential growth patterns by maternal PHIV status, and included an interaction term for child age by maternal PHIV status along with inverse probability weights to account for administrative censoring. Results: 1236 infants had height and weight measured from birth (252 and 984 were born to women with PHIV vs NPHIV, respectively). Women with PHIV were younger (23 vs 25 yrs, p<0.01), had lower median CD4 count (386 vs 496 cells/ mm³, p<0.01), and were more likely to have HIV RNA level > 400 copies/mL at delivery (25% vs 12%, p<0.01). A smaller percentage of infants born to women with PHIV were black (63% vs 74%, p<0.01). In the model limited to black female children (n=415), those born to women with PHIV had lower birth WTZ (mean difference: -0.22 [95% confidence intervals (CI): -0.41, -0.03]) and similar WTZ trajectories from 0-3 yrs (slope difference: -0.06 [95% CI: -0.16, 0.04]), but more rapid weight gain after 3 yrs (slope difference: 0.10 [95% CI: 0.00, 0.19]) than those of women with NPHIV; the overall mean difference (PHIV vs NPHIV) between 0-7 years was -0.30 (95% CI: -0.50, -0.09). (Figure 1) Within the other race and sex strata, no differences in overall WTZ or WTZ trajectories were found in HEU children of women with PHIV vs NPHIV. The growth trajectories of HTZ and WLZ/BMIZ over time, as well as overall means, did not differ between children of women with PHIV and NPHIV. Conclusion: In general, children of women with PHIV had similar growth compared to those of women with NPHIV, which is reassuring. However, black female children of women with PHIV vs NPHIV may be at increased risk for lower weight through early childhood.

1 Hvidovre Hospital, Hvidovre, Denmark, 2 Copenhagen University Hospital, Copenhagen, Denmark, 3 Aarhus University Hospital, Aarhus, Denmark, 4 Aalborg University Hospital, Aalborg, Denmark, 5 Odense University Hospital, Odensen, Denmark Background: Studies mainly from resource-limited settings have shown impaired growth among HIV-exposed uninfected (HEU) children. We aimed to compare anthropometric outcomes of Danish HEU children to a matched control group of children not exposed to HIV in the first 5 years of life. Methods: In a nationwide register-based study we included all singleton HEU children born in Denmark, 2000-2016. HEU children were individually matched by parity, maternal age at birth, maternal ethnicity and child sex to five singleton controls born to HIV uninfected mothers. Weight-for-age (WAZ), length-for-age (LAZ) and BMI-for-age (BMI) z-scores were generated according to the WHO standards and the Fenton growth chart for prematurity for infants born <37 week. Differences in WAZ, LAZ and BMI z-scores were analyzed using linear mixed models, adjusting for maternal smoking and total number of growth measurements. Results: In total, 493 HEU children and 2.495 controls were included, with a mean of 5 growth measurements in each group (range: 1-23). HIV-infected mothers were more likely to smoke during pregnancy (11% vs. 7%) and their infants were more likely to be born preterm (<37 weeks) (11% vs 5%) and to be delivered by Caesarean Section (66% vs. 27%). Most HIV-infected mothers were fully suppressed at the time of delivery with HIV RNA levels <50 copies/ mL (87%). Overall, both HEU and control group children had normal growth with z-scores close to or above the average population mean of 0 (Figure 1). Compared to controls, HEU children were smaller at birth with a difference in mean WAZ and LAZ scores of -0.26 (95%CI -0.40:-0.13; p=<0.001) and -0.44 (95%CI -0.69:-0.29: p=<0.001), respectively. Over time, there was a trend towards increasing WAZ and LAZ in HEU children, and there was no significant difference in WAZ z-scores by age 12 months (-0.10 (95%CI -0.26:0.06: p=0.22) and no significant difference in LAZ z-scores by age 24 months (-0.13 (95%CI -0.32; 0.04: P=0.15). There was no difference in BMI-for-age between the two groups at any age. A sensitivity analysis limited to children with information on breastfeeding did not change results significantly. Conclusion: In a high-resource setting, exposure to HIV and/or antiretroviral therapy does not seem to be adversely associated with infant and child growth. Compared to a matched control group, HEU children were smaller at birth, but this difference decreased with time and is not considered to have a negative impact the overall health and well-being of HEU children.

Poster Abstracts

795 IN UTERO HIV EXPOSURE IS LINKED TO OBESITY AND REACTIVE AIRWAY DISEASE IN ADOLESCENCE Lindsay T. Fourman , Marisa E. Gerard, Chelsea S. Pan, Virginia Triant, Takara L. Stanley, Steven K. Grinspoon Massachusetts General Hospital, Boston, MA, USA Background: With the implementation of prenatal ART, 98% of individuals born to mothers with HIV are HIV-exposed but uninfected (HEU). HEU infants

794 POSTNATAL GROWTH IN CHILDREN EXPOSED OR UNEXPOSED TO HIV: A NATIONWIDE COHORT STUDY Ellen Moseholm 1 , Marie Helleberg 2 , Terese L. Katzenstein 2 , Merete Storgaard 3 , Gitte Pedersen 4 , Isik S. Johansen 5 , Håkon Sandholdt 1 , Nina Weis 1

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