CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

477 CORRELATES OF DRUG RESISTANCE MUTATIONS IN ART-NAÏVE INDIVIDUALS WITH HIV INFECTION Sarah E. Porter 1 , Ellsworth Campbell 1 , Emily Westheimer 2 , Cynthia L. Gay 3 , Stephanie E. Cohen 4 , Anupama Shankar 1 , Jin-Fen Li 1 , Jeffrey A. Johnson 1 , WilliamM. Switzer 1 , Philip J. Peters 1 1 CDC, Atlanta, GA, USA, 2 New York City DHMH, New York, NY, USA, 3 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 San Francisco Dept of Pub Hlth, San Francisco, CA, USA Background: Testing for HIV transmitted drug resistance mutations (TDRM) is recommended for persons with newly diagnosed HIV infection to aid selection of antiretroviral therapy (ART). In order to assess the potential of drug resistance testing to inform public health interventions, we evaluated the correlates of TDRM in ART-naïve patients using data from a multi-state study of acute HIV infection conducted between 2011 and 2013. Methods: This analysis included 539 of 1326 (44%) HIV-positive study participants with available genotypic HIV drug resistance results and first HIV-positive test ≤91 days prior to study enrollment. A diagnostic testing algorithmwas used to classify all infections as acute HIV infection (AHI) or established HIV infection (EHI), and 499 (93%) participants were interviewed about HIV risk behaviors. HIV transmission clusters were identified through genetic distance-based cluster analysis of HIV-1 polymerase sequences. We used logistic regression to assess correlation of TDRM in NRTI, NNRTI, or PI classes with AHI, cluster size, and HIV risk behaviors. Results are reported as odds ratios adjusted for study site and demographic factors (aOR) and 95% confidence intervals (CI). Results: The characteristics of individuals in the analysis were: median age 30 years, 95%male, 83%men who have sex with men, and race/ethnicity distribution was 35%white, 32% black, and 20% Hispanic. Overall, 129 (24%) individuals had acute HIV infection, and 135 (25%) were part of a transmission cluster with ≥2 participants. NNRTI class resistance was most common (12%), followed by resistance to NRTI (6%) and PI (4%) classes. TDRM was found in 20% (95% CI: 13-27%) of AHI and in 17% (95% CI: 13-21%) of EHI (aOR: 1.0, 95% CI 0.6-1.8). Persons in transmission clusters with ≥3 individuals were more likely to have TDRM compared to those with fewer genetic links (aOR: 2.5, 95% CI 1.3-4.8). We found no association between TDRM and sex with an HIV-positive partner in the study (aOR: 0.8, 95% CI: 0.4-1.4), meeting a sex partner online (aOR: 0.9, 95% CI 0.5-1.6), or reporting ≥10 sex partners in the past 12 months (aOR: 1.6, 95% CI 0.8-2.9). Conclusion: Among ART-naïve HIV-positive individuals, persons within larger transmission clusters had a higher risk of TDRM in our analysis. We found no association between TDRM and AHI or the HIV risk behaviors we assessed. Enhanced partner services may be warranted for persons with TDRM to improve HIV case finding, particularly for those with drug-resistant HIV infection. 478 HIV INTEGRASE GENOTYPIC TESTING AND RESISTANCE IN THE UNITED STATES—9 JURISDICTIONS Angela L. Hernandez 1 , M. Cheryl B. Ocfemia 1 , Neeraja Saduvala 2 , Alexandra Oster 1 , Walid Heneine 1 , Jeffrey A. Johnson 1 , Irene Hall 1 1 CDC, Atlanta, GA, USA, 2 ICF Intl, Atlanta, GA, USA Background: In 2016, national drug resistance testing guidelines were updated to recommend providers include integrase (IN) genotypic testing at entry into HIV care if transmitted resistance to integrase strand transfer inhibitors (INSTI) is a concern. We used National HIV Surveillance System (NHSS) data to assess the prevalence of IN genotypic testing and INSTI-associated resistance. Methods: We analyzed HIV-1 sequences from persons with HIV infection diagnosed through 2014 and reported to NHSS by December 2015 from 9 surveillance jurisdictions (Colorado, Connecticut, California [Los Angeles County], Michigan, New York, Philadelphia, South Carolina, Texas, and Washington). We describe (1) overall prevalence and timing of IN genotypic tests after HIV diagnosis (≤3 months and >3 months) by sex, age, race/ethnicity, transmission category, stage of HIV disease, population of area of residence at diagnosis, and antiretroviral use (ARV) at diagnosis, and (2) prevalence of INSTI-resistant associated mutations using the updated CDC HIV-1 surveillance mutation list. Results: We analyzed 14,468 IN sequences; 7,107 (49%) sequences were IN only. IN genotypic testing was more common among males, persons aged 20-29 years, blacks; by transmission category, more common among males with HIV infection attributed to male-to-male sexual contact, heterosexual females, persons who were not stage 3 of HIV disease (AIDS), and persons residing in areas with a population of >500,000. Prevalence of INSTI-resistant mutations among all IN sequences was extremely low (65/14,468; 0.4%). Of these, the most prevalent mutations were N155H (38%), followed by E92Q (29%) and G140S (25%). IN genotypic testing was performed ≤3 months after diagnosis for 5,240 (36%) persons, of which 4,631 (88%) had no evidence of ARV use; 2 (0.04%) had transmitted INSTI-associated resistance (N155H [100%]; E92Q [50%]). Conclusion: INSTI-resistant mutations are rare and indicate that current INSTI-based regimens remain effective. A majority of genotypic testing for resistance to INSTIs occurs more than 3 months of HIV diagnosis likely after initiation of antiretroviral therapy. NHSS provides the opportunity to monitor IN genotypic testing and prevalence of INSTI- associated resistance at a population level.

Poster and Themed Discussion Abstracts

CROI 2017 200