Amsterdam 2015
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| Abstract #2097 - Pregnancy and HIV | ||||
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Session: 14.4: Pregnancy and HIV (Symposium) on Wednesday @ 14.30-16.00 in C103 Chaired by Sibylle Niderost, Sandra Van Den Eynde Authors: Presenting Author: Dr Sera Young - Cornell University, United States |
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| Additional Authors: | ||||
| Aim: Household food insecurity, or insufficient access to sufficient, safe and nutritious foods, has predicted poor HIV outcomes in non-pregnant populations, including incomplete viral suppression. However, little is known about the consequences of food insecurity for maternal and child health, especially in the context of HIV. Further, the relationship between food insecurity and virologic outcomes has never to our knowledge been examined in pregnant and lactating women. Therefore, our aim was to determine if food insecurity was associated with viral suppression in a cohort of HIV-infected pregnant and breastfeeding Ugandan women. | ||||
| Method / Issue: Analyses are based upon data from 197 HIV-infected, antiretroviral therapy (ART)-naïve pregnant women in Tororo, Uganda actively enrolled in the PROMOTE trial (NCT00993031) between July 2011 to February 2012. Participants were randomized to start lopinavir/ritonavir (LPV/r) or efavirenz (EFV)-based ART at 12-28 weeks of pregnancy. Food insecurity was assessed after delivery in the season of lowest food insecurity (July to February). Food insecurity was operationalized using the Household Hunger Scale, a subset of 3 questions about food quantities from the Household Food Insecurity Access. Food insecurity responses were dichotomized as either no household hunger or any household hunger (any positive response). Logistic regression was used to model the association between sustained viral suppression (HIV-1 RNA =400 c/ml after 8 weeks on ART, at delivery, and at 8, 24, and 48 weeks postpartum) and food insecurity. Covariates included ART arm, baseline HIV-1 RNA, baseline body mass index (BMI), maternal age, and household assets. | ||||
| Results / Comments: At enrolment, median CD4 cell count was relatively high, at 384 cells/mm3 (IQR 271-506), and median log10 HIV-1 RNA was 4.3 c/ml (IQR 3.5-4.9). Three-quarters (74.1%) of women experienced household food insecurity. Seventy-nine food insecure women (59.4%) achieved sustained viral suppression to 48 weeks postpartum, compared to 77.8% of food secure women (P=0.03).In multivariate models of sustained viral suppression, women who experienced household hunger had 58% lower odds of sustained viral suppression (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.18-0.97). Pretreatment HIV-1 RNA concentration (aOR 0.60 per 10-fold increase, 95% CI 0.40-0.88) and lopinavir/ritonavir vs. efavirenz (aOR 0.46, 95% CI 0.23-0.89) were also negatively associated with sustained viral suppression (8 weeks on ART-48 weeks postpartum). Conversely, enrolment BMI (aOR 1.17 per kg/m2, 95% CI 1.03-1.33) was positively associated with sustained viral suppression. | ||||
| Discussion: In this population of HIV-infected pregnant and lactating women with high median CD4 cell count, food insecurity was strongly associated with a lower odds of sustained viral suppression to 48 weeks postpartum. Mechanisms underpinning this association should be explored. Interventions to alleviate food insecurity may lead to improved virologic outcomes during pregnancy and breastfeeding, when viral suppression has implications for preserving maternal health and reducing the risk of perinatal transmission. | ||||
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