CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

resistance to nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) from a population-based study conducted across Botswana communities. Methods: Blood samples were collected from 2343 HIV-positive individuals residing in 25 communities across Botswana (South, East and North) who participated in the Botswana Combination Prevention Project (BCPP) in 2013-2015. HIV sequences were obtained by a long-range HIV genotyping. NRTI, NNRTI and PI resistance mutations were analyzed according to the WHO 2009 and IAS-USA 2015 lists. Viral sequences were screened for G-to-A hypermutations (HM). Mutations in sequences with adjusted HM rate above 2% were considered to be generated by HM, and were not counted toward drug- resistant mutations (DRMs). Viral suppression was considered at HIV-1 RNA less than or equal to 400 copies/mL. Results: Among analyzed 2343 participants, prevalence of mutations associated with NRTI-, NNRTI- and PI-drug resistance was 2.9%, 3.2% and 1.2%, respectively. Prevalence of drug resistance to any drug class (NRTI, NNRTI or PI) was 5.8% (95% CI: 4.9–6.8%), and did not differ between 3 major regions of Botswana: North (4.7%), East (5.7%) and South (6.4%). ART status was documented for 2225 (95%) participants. Among individuals on ART (n=1583), 96%were virologically suppressed and had prevalence of NRTI-, NNRTI- and PI- associated mutation at 2.0 %, 2.6% and 1.3%, respectively. Among individuals on ART who were not suppressed (n=63), NRTI-, NNRTI- and PI-associated mutation were found in 22%, 24% and 0%, respectively. Among HIV-infected individuals not on ART (n=642), NRTI-, NNRTI- and PI-associated mutation were found in 3.3%, 2.0% and 0.9%, respectively. The overall distribution of specific mutations to 3 classes of drugs is presented in Table 1. Conclusion: Low prevalence of NRTI-, NNRTI- and PI-drug-resistant mutations was found among residents of 25 communities across Botswana. However, individuals on ART with detectable virus had prevalence of NRTI and NNRTI mutations above 20%. Monitoring of HIV mutations associated with drug- resistance is important during broad scale-up of the treat-all national policy in Botswana.

organs were used for transplantation and those who were not used. ART- resistance and viral co-receptor tropismwere determined in viremic individuals using the Genosure Prime and standard Trofile assays; and in virally suppressed individuals using the Genosure Archive and Trofile DNA assays (Monogram Biosciences). Results: Of 36 potential HIVDD with sufficient blood collected for the study, five provided organs for HIV+ to HIV+ transplants (T group). The remaining were evaluated as research only (RO group). Differences in age were seen among the groups with the T group being younger (mean age=30.2 vs 48.1). Thirty-one subjects were successfully genotyped for ART-resistance. In the T group, 80.0% of subjects (n=4) had successful genotyping with only one HIVDD showing drug resistance to NRTIs (Table 1). 60% (n=3) of the T group yielded tropism results with 100% using CCR5. In the RO group (n=27), seven subjects (25.9%) had resistance to one or more ARVs (Table 1). 71% (n=22) of the RO group were successfully phenotypes for co-receptor tropismwith 45.5% (n=10) using CCR5 exclusively, and 54.5% (n=12) being mixed or dual-tropic (CCR5 and CXCR4). Conclusion: This is the first report classifying the preliminary levels of ART-resistance and viral tropism in the HIVDD pool in the US. Levels of ART- resistance and CXCR4-tropismwere comparable to levels reported in the general population. With the passage of the HIV Organ Policy Equity (HOPE) Act, and the first successful HIV+ to HIV+ kidney and liver transplants occurring in the US, it is important to better understand the underlying risk within this unique donor population.

Poster Abstracts

554 IMPROVED CARE OF SOCIALLY DISADVANTAGED PATIENTS IS NEEDED TO REDUCE DRUG RESISTANCE Irene A. Abela 1 , Alexandra Scherrer 1 , Jürg Böni 2 , Sabine Yerly 3 , Thomas Klimkait 4 , Matthieu Perreau 5 , Manuel Battegay 6 , Hansjakob Furrer 7 , Alexandra Calmy 3 , Patrick Schmid 8 , Matthias Cavassini 5 , Enos Bernasconi 9 , Huldrych F. Günthard 1 1 University Hospital Zurich, Zurich, Switzerland, 2 University of Zurich, Zurich, Switzerland, 3 University Hospitals of Geneva, Geneva, Switzerland, 4 University of Basel, Basel, Switzerland, 5 Lausanne University Hospital, Lausanne, Switzerland, 6 University Hospital Basel, Basel, Switzerland, 7 University Hospital of Bern, Bern, Switzerland, 8 St. Gallen Cantonal Hospital, St. Gallen, Switzerland, 9 Servizio di Malattie Infettive, Lugano, Switzerland Background: The rate of acquired HIV-1 drug resistance (ADR) has fallen dramatically over recent years since introduction of combined antiretroviral therapy (cART) in Switzerland (Scherrer, CID, 2016,15;62(10):1310). However, clinical experience indicates that there are still patient subgroups in which ADR remains a therapeutic challenge. Here, we aimed at characterizing risk factors for ADR, in order to improve patient care and prevent treatment failure. Methods: We performed a case-control study to identify risk factors for ADR in all patients starting their first cART regimen in the Swiss HIV Cohort Study (SHCS) since 1996. Hundred-fifteen cases with ADR were randomly matched with 115 controls without ADR. Matching criteria were viral load, first year of cART initiation, transmitted drug resistance and SHCS center. Furthermore, we performed a systematic medical chart review to obtain more detailed information on 20 additional parameters not routinely collected in the SHCS, i.e. psychosocial characteristics (e.g. migratory background, language barrier), adherence, psychiatric disorders, and side effects. We performed univariable conditional logistic regressions and implemented a stepwise forward selection adding terms with p<0.1 in the multivariable model. Results: Compared to controls, a high proportion of patients with ADR mutations were migrants (48% vs 27%), were in unstable job situations (67%

553 ARV RESISTANCE AND CO-RECEPTOR TROPISM IN HIV+ DECEASED ORGAN DONORS IN THE US Gilad Bismut 1 , Christine Durand 2 , Diane M. Brown 2 , Brianna Doby 3 , Shanti Seaman 2 , Michael Seisa 4 , Christos Petropoulos 4 , Reinaldo Fernandez 2 , Dorry Segev 1 , Aaron Tobian 1 , Andrew D. Redd 5 1 The Johns Hopkins University, Baltimore, MD, USA, 2 Johns Hopkins University, Baltimore, MD, USA, 3 Positive Rhetoric, LLC, Denver, CO, USA, 4 Monogram BioSciences, San Francisco, CA, USA, 5 NIH, Bethesda, MD, USA test for these risk factors by obtaining viral genotypes and phenotypes is substantially greater than the window period for transplantation. Examining HIVDD for risk factors associated with ART-resistance and CXCR4 tropismmay allow physicians to more accurately predict resistance in potential donors. Methods: Blood from potential HIVDD were obtained from 11 distinct organ procurement organizations throughout the United States. Demographic, virologic, and serology data were evaluated in two groups, subjects whose Background: In HIV+ to HIV+ organ transplantation, there is a theoretical risk of transmitting ART-resistant or CXCR4-tropic virus from HIV-infected deceased donors (HIVDD). Furthermore, the time required for a laboratory to definitively

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