Laura Waters

These oral abstracts covered pregnancy outcomes in women with HIV (including the impact of vaginal inflammation and the obesity), NTD rates in the antiretroviral pregnancy registry (APR) and viral suppression rates in ART-treated women in South Africa.

In the IMPROVE study, 89% of pregnant women with HIV received ART. Adjusted composite adverse pregnancy outcomes were 2-3 fold higher than for HIV-negative women. A study across tertiary obstetric units showed 1/3 and 1/5 had VL >50 & >1000 at delivery. Scale-up of care & VL monitoring is urgently required to achieve VL suppression at delivery and during breastfeeding. The APR requires 2000 1st trimester exposures to rule out a 3-fold increase in rare events like NTDs. NTD prevalence was 0.40% for DTG (0.14% for InSTIs) based on one event. A study of 877 women, half with HIV, demonstrated more hazardous alcohol use & hypertension in those with HIV but less obesity. Obesity was associated with negative outcomes only in HIV-negative women. Vaginal inflammation in pregnancy is associated with pre-term delivery. The ZAPPS Study in Zambia showed pregnant women with HIV have more inflammation further increased if initiating ART

Women with HIV remain at higher risk of adverse pregnancy outcomes & implications for monitoring and ART choice are important to understand. However, ART without sufficient support & monitoring risk detectable viraemia at delivery and consequent onward transmission. Current reports of INSTI exposure to APR are too small to confirm/refute any association with NTD; most data come from North America, where food folic acid fortification is routine. Obesity is associated with negative outcomes in HIV-negative women but not, so far, in women with HIV. The impact of ART-associated weight gain on pregnancy requires investigation.