935. Repeat Pregnancies Among Women Living with HIV: Evaluating temporal changes in HIV disease status and exploring the association between preterm birth and protease inhibitor use in pregnancy.
Session: Oral Abstract Session: HIV-Related Comorbidities and Complications
Friday, October 5, 2018: 9:15 AM
Room: S 157

Background: With improved treatment, women living with HIV (WLHIV) are increasingly becoming pregnant. Studies have shown suboptimal viral suppression following pregnancy.  In addition, protease inhibitors (PI) have been associated with preterm birth (PTB). 

Methods: We studied WLHIV with at least 2 live births while on the PHACS SMARTT study. We first compared CD4 counts and viral loads (VL) between the 1st and 2nd pregnancies using Wilcoxon rank sum tests. We then examined trends in these measures over all reported pregnancies using mixed effect linear regression models adjusting for maternal age and birth year, with a random effect to account for repeated measures in the same woman over time.  Finally, we evaluated the association of PI or Non-PI use during pregnancy with PTB, using GEE logistic regression models to adjust for pregnancy number, maternal age, and birth year.

Results: Between 2007 and 2018, 699 women had >1 pregnancy while on study, with a total of 1642 children. Their mean CD4 counts remained stable over repeat pregnancies. Their mean log10 VL decreased between the 1st and 2nd pregnancies, both early and late in pregnancy (-0.42 cp/mL and -0.16 cp/mL respectively, p<0.001 for each), but increased by 0.61 cp/mL (p<0.001) between the end of the 1st pregnancy and early in the next pregnancy.  Most women had VL suppression during pregnancy with VL rebound by the next pregnancy (Fig.).

A majority of women (55%) received a PI in both their 1st and 2nd pregnancies, with an increase in PTB rate of 4.3%, whereas those who changed from a PI to a non-PI had a decrease of 4.7% (Table). Changing to a PI resulted in a stable rate, whereas remaining on a non-PI resulted in a drop of 2%.  In adjusted models including all pregnancies, 1st trimester PI use was associated with an increased rate of PTB (adjusted OR 1.35; 95% CI 1.02, 1.97).

Conclusion: Most WLHIV achieved VL suppression during pregnancy, but many had a VL rebound after pregnancy. First trimester PI use was associated with higher risk of PTB.

Table Paired Group and PTB

Paired Pregnancy Regimen Group

1st / 2nd pregnancy

Percent of PTB

1st pregnancy

2nd pregnancy

Difference

Non-PI/ Non-PI          (n=103)

 11.7%

9.7%

-2.0%

Non-PI/ On PI (n=91)

15.4%

15.4%

 0%

On PI/ Non-PI (n=86)

16.3%

11.6%

-4.7%

On PI/ Stayed on PI (n=351)

14.8%

19.1%

+4.3%

 

Figure Percent of women with unsuppressed VL (>400 cp/mL)

Brigid O'Brien, DO, MS1, Paige Williams, PhD2, Deborah Kacanek, ScD3, Ellen Chadwick, MD4, Kathleen Powis, MD, MPH5, Katharine Correia, MA, Biostatistics3, Lisa B. Haddad, MD, MS, MPH6, Lynn Yee, MD, MPH7, Nahida Chakhtoura, MD8, Chi Dola, MD, MPH9, Russell B. Van Dyke, MD10 and The Pediatric HIV/AIDS Cohort Study, (1)Pediatrics, Tulane University, New Orleans, LA, (2)Harvard T.H. Chan School of Public Health Departments of Biostatistics and Epidemiology, Boston, MA, (3)Harvard TH Chan School of Public Health, Boston, MA, (4)Professor of Pediatrics, Northwestern University Feinberg School of Medicine, Chair in Pediatrics Director, Section of Pediatric, Adolescent and Maternal HIV Infection, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, (5)Massachusetts General Hospital, Departments of Internal Medicine and Pediatrics, Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, MA, (6)Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, (7)Northwestern University Feinberg School of Medicine, Chicago, IL, (8)Eunice Kennedy Shriver, National Institute of Child Health and Human Development, Bethesda, MD, (9)Tulane School of Medicine, Department of Obstetrics and Gynecology, New Orleans, LA, (10)Tulane University School of Medicine, Professor and Head, Section of Infectious Diseases, New Orleans, LA

Disclosures:

B. O'Brien, None

P. Williams, None

D. Kacanek, None

E. Chadwick, Abbott Labs: Shareholder , stock dividends . AbbVie: Shareholder , stock dividends .

K. Powis, None

K. Correia, None

L. B. Haddad, None

L. Yee, None

N. Chakhtoura, None

C. Dola, None

R. B. Van Dyke, Giliad Sciences: Grant Investigator , Research grant .

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