Determinants of HIV-free survival in the era of lifelong universal antiretroviral therapy (ART): pooled analysis of PEAWIL and IMPROVE studies, Lesotho
BACKGROUND: We assessed factors associated with HIV-free survival (HFS) among HIV-exposed infants, pooling data from two Lesotho cohorts in the universal ART era.
METHODS: PEA-WIL, an observational study (6/2014-9/2018), and IMPROVE, a randomized trial (7/2016-7/2019), enrolled HIV-positive pregnant women attending antenatal care (ANC) in Lesotho under universal ART guidelines, with mother-baby follow-up through 12-24 months postpartum, to evaluate a facility-based intervention package to improve patient care. There was no significant difference in HFS between arms, so arms were combined. Kaplan Meier analysis was used to estimate mortality and HFS rates, censoring for loss to follow-up or withdrawal; multivariate logistic regression was used to identify factors independently associated with HFS.
RESULTS: A total of 1,205 HIV-positive women were enrolled in combined cohorts; median maternal age was 28 (IQR:24'32) years and 80.1% were married/living with a partner. At delivery, 99.3% of women were receiving ART. Of 1,178 (96.4%) live births, 8.4% were preterm, 97/1,103 (17.9%) had a birth weight <2500 g, and 91.4% were breastfed at birth with 35.9% breastfed for >6 months. Estimated 2-year HFS was 93.4% (95%CI 92'95%) (Figure)'most rapid decline from birth-6 months, plateauing at age 1 year. In adjusted analyses, HFS was significantly associated with maternal age ('¥25 vs. <25 years) (aOR 2.4, 95% CI 1.4'4.3), HIV disclosure to partner (aOR=2.0, 95% CI 1.04-3.8), gestational age at birth (>37vs'¤ 37-weeks) (aOR=3.7, 95%CI 1.6'8.4), and breastfeeding for >6 months (aOR=2.4, 95%CI 1.2-5.0). In a multivariate model with birth weight instead of gestational age, birth weight <2,500 g was associated with lower HFS (aOR=0.4, 95%CI 0.2'0.8).
CONCLUSIONS: In an era of universal ART in pregnant women, higher HFS was associated with older maternal age, partner disclosure, and breastfeeding for at least six months; while lower in infants born preterm or low birth weight.
A. Tiam * (1), R. Machekano (2), V. Tukei (3), M. Mokone-Mohape (3), L. Greenberg (4), M. Masitha (3), L. Mofenson (2), L. Guay (2)
(1) Elizabeth Glaser Pediatric AIDS Foundation, Technical Strategy and Innovation, Washington, United States, (2) Elizabeth Glaser Pediatric AIDS Foundation, Research, Washington, United States, (3) Elizabeth Glaser Pediatric AIDS Foundation, Research, Maseru, Lesotho, (4) Elizabeth Glaser Pediatric AIDS Foundation, Washington, United States