483: Social vulnerability among foreign-born pregnant women and maternal virologic control of HIV

Abstract

Markers of social vulnerability, such as lack of social support or recent immigration, may be associated with poor viremic control of HIV, which has important implications for maternal-to-child transmission (MTCT) and long-term maternal health. We investigated whether social vulnerability among foreign-born pregnant women living with HIV (WLHIV) was associated with maternal viremia during pregnancy. This cohort study included all foreign-born pregnant WLHIV who received prenatal care through a multidisciplinary prenatal clinic between 2009 and 2018. A Licensed Clinical Social Worker evaluated all women and kept detailed clinical records on immigration status and social support. For this analysis, social vulnerability was defined as both living in the United States for less than 5 years and reporting no family or friends for support. The primary outcome was evidence of viral non-suppression after achievement of initial suppression. Secondary outcomes were the proportion of women that took > 12 weeks after starting antiretroviral therapy to achieve viral suppression and those missing ≥ 5doses of antiretroviral therapy. Bivariable analyses were performed. A total of 111 foreign-born women were eligible for analysis, of whom 25 (23%) were classified as socially vulnerable. Social and clinical characteristics of women diverged by social vulnerability categorization but no differences reached statistical significance (Table 1). On bivariable analysis, socially-vulnerable women were at increased risk for viremia during pregnancy and needing > 12 weeks to achieve viral suppression, though there was no association with missing ≥ 5doses of antiretroviral therapy(Table 2). Among foreign-born, pregnant WLHIV, markers of virologic control during pregnancy were noted to be worse among socially-vulnerable women. Insofar as maternal viremia is the predominant driver of MTCT, closer clinical surveillance and support may be indicated in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)