EACS2023: 207 Association between the timing of maternal anti-retroviral therapy, CD4 count and viraemia, and birth outcomes S. Siqithi , O.,. Adeniyi Walter Sisulu University, Paediatrics, East London, South Africa, Walter Sisulu University, Family Medicine, East London, South Africa General data Abstract category: Antiretroviral therapy – observational studies Abstract body Purpose: Several reports have documented adverse birth outcomes (stillborn, low birth weight and prematurity) from maternal antiretroviral therapy. However, there is no consensus on whether exposure to maternal ART differs by timing of initiation and HIV-related factors. Given that South Africa has the largest programme on the prevention of mother-to-child transmission , it is imperative to examine the effect of timing of maternal ART initiation, CD4 count and viral load on birth outcomes. Method: This retrospective cohort study involved 1709 mother-infant pairs enrolled in the PMTCT programme in the Eastern Cape, South Africa between 2015 - 2018,it examined association between maternal HIV-related factors and birth outcomes.Birth outcomes (stillborn, low birth weight, and premature) and maternal indicators (CD4 count and viral load) were extracted, and analysed using modified Poisson regression analysis. Results: Of the total (N=1709), about 90% of the mothers were treated with first line ART regimen; 84.1% (TDF-based regimen) and 4.2% (non-TDF-based regimen). Overall, 24 babies were delivered as stillborn out of 1700 live births (1.4%). Low birth weight occurred in 302 of 1676 live births (18%) while 27% of the babies were preterm deliveries. The timing of ART initiation and preterm delivery showed no association. Low CD4 count (<200) and maternal viraemia were associated with increased risk of preterm delivery. Women who initiated ART in the second trimester had a higher risk of having low birth weight babies compared to those with pre-conception ART. Maternal viraemia (low viraemia and high viral load) were significantly associated with increased risk of low-birth-weight babies. No significant association between maternal CD4 count and low birth weight. Conclusions: Adverse birth outcomes (low birth weight and preterm delivery) were significantly associated with maternal viraemia rather than ART initiation. As such, early initiation of ART and achieving viral suppression should be prioritised in all pregnant women with HIV. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 2 1 2 88 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
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