CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

classes INI-R decreased from 45.7% to 20.6% (p=0.006), in conjunction with an increased full GS to INIs (Figure 1C). Similar trends were found in isolates under INI+2NRTIs (Figure 1D). In isolates under INI-based dual therapy, INI-R remained stable from 2009 to 2017 (~36%) in conjunction with a stable proportion of isolates with full GS to RAL and EVG (Figure 1E). Whereas, under INI-based dual therapy, full GS to DTG or BIC slightly decreased from 96.3% to 84.7% (p=0.077; Figure 1E). In the 374 INI-treated pts the cumulative prevalence of INI-R was 33.4%. Pts who experienced only DTG showed lower cumulative INI-R compared to those who experienced only RAL or EVG or more than one INI (DTG: 7.7%; RAL: 32.1%; EVG: 45.2%; >1 INI: 41.9%, p=0.060). 46 (12.3%) pts showed cumulative four-drug class resistance. Of them, only 21 (45.7%) showed full GS to DTG or BIC. Conclusion: INI-R is decreasing in Italy, confirming a good clinical practice. However, the first cases of transmitted INI-R, the stable INI-R prevalence under dual regimens and the consistent proportion of INI-exposed pts showing exhausted treatment options remain important concerns. These findings confirm that INI-R monitoring remains crucial for all categories of pts to avoid loss of treatment options.

1 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 3 FHI 360, Durham, NC, USA, 4 University of North Carolina in Vietnam, Hanoi, Vietnam, 5 Ukrainian Institute on Public Health Policy, Kyiv, Ukraine, 6 University of Indonesia, Jakarta, Indonesia, 7 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 8 The Ohio State University, Columbus, OH, USA Background: People who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. We analyzed baseline HIV drug resistance and antiretroviral (ARV) drug use among PWID enrolled in a clinical study conducted in Indonesia, Vietnam, and Ukraine: HIV Prevention Trials Network (HPTN) 074. Methods: HPTN 074 enrolled 502 HIV-infected index participants who had a viral load ≥1,000 copies/mL; 54 (11%) reported that they were on ART at enrollment. HIV genotyping was performed using the ViroSeq HIV-1 Genotyping System for index participants who had HIV viral loads >400 copies/mL at enrollment. ARV drug testing was performed using a qualitative assay that detects 20 ARV drugs in five drug classes. Results: HIV drug resistance was detected in HIV from 54 (12.0%) of 449 participants; 29 (53.7%) of the 54 participants had multiclass resistance (non- nucleoside reverse transcriptase inhibitor [NNRTI] + nucleoside/nucleotide reverse transcriptase inhibitor [NRTI] resistance). The most common resistance mutations detected were K103N and M184V. ARV drugs were detected in samples from 51 (11.4%) of the 449 participants: 37 (72.5%) had an NNRTI with one or two NRTIs, 10 (19.6%) had an NNRTI only, and two (3.9%) had a boosted protease inhibitor with one or two NRTIs; two participants had an unusual combination of ARV drugs detected (two NNRTIs and one NRTI). Almost half of the participants who had ARV drugs detected (23/51=45.1%) did not have resistance to at least one of the ARV drugs detected, indicating that they were at risk of acquiring additional resistance mutations. The prevalence of drug resistance was significantly higher among those with ARV drugs detected than in those with no ARV drugs detected (30/51=58.8% vs. 24/398=6.0%, p<0.001). Drug resistance was also detected more frequently among participants in Indonesia (27/112=24.1%) compared to Ukraine (4/165=2.4%; p=0.001) or Vietnam (23/172=13.4%; p=0.014), and among participants who reported a history of incarceration compared to those who did not (6/14=42.9% vs. 48/435=11.0%; p=0.012). Conclusion: This study revealed a high prevalence of HIV drug resistance and multiclass drug resistance in a cohort of PWID from Eastern Europe and Asia. This is likely to impact use of ARV drugs for HIV treatment and prevention, and highlights the need for improved HIV care in this high-risk population. 535 INI-RESISTANCE DYNAMICS FROM 2007 TO 2017 IN ITALIAN CLINICAL ISOLATES Daniele Armenia 1 , Caterina Gori 2 , Ada Bertoli 1 , Vanni Borghi 3 , Alessandra Latini 4 , Roberta Gagliardini 2 , Miriam Lichtner 5 , Federica Forbici 2 , Francesco Montella 6 , Cristina Mussini 3 , Massimo Andreoni 7 , Andrea Antinori 2 , Francesca Ceccherini Silberstein 1 , Carlo Federico Perno 2 , Maria M. Santoro 1 1 University of Rome Tor Vergata, Rome, Italy, 2 IRCCS Lazzaro Spallanzani, Rome, Italy, 3 University of Modena and Reggio Emilia, Modena, Italy, 4 San Gallicano Dermatology Institute, Rome, Italy, 5 Sapienza University of Rome, Rome, Italy, 6 Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy, 7 Hospital of Rome Tor Vergata, Rome, Italy Background: We evaluated the prevalence of resistance to integrase inhibitors (INIs) over-time in clinical isolates from HIV-1 infected patients (pts) according to the type of treatment received. Methods: We included 3004 integrase plasma genotypic resistance tests (GRTs) from 2598 HIV-1 infected pts (INI-naïve [drug-naïve and -experienced] and INI-treated). INI-resistance (INI-R) prevalence and genotypic susceptibility (GS) were evaluated from 2007 to 2017. To estimate the extent of pts with limited drug-options, cumulative class resistance (≥1 major resistance mutation [MRM] (p=0.001), in conjunction with an increased full GS to all INIs (p<0.05; Figure 1A). Among 2493 isolates from INI-naïve pts (N=2224), INI-R was stably low over time (≤1.3%) in association with a high GS to all INIs (≥96.8%; Figure 1B). INI MRMs were found in 10 drug-naïve pts: T66I (N=1); E138K (N=1); Y143C/H/R (N=1); Q148H+G140S (N=1); N155H (N=1); R263K (N=5). Among 511 isolates from 374 INI-treated pts, INI-R decreased from 42.9% in 2007 to 27.8% in 2017 (p=0.039). Concerning the type of treatment, in isolates under INI+≥2 drug to PI, NRTI, NNRTI and/or INI among all GRTs available) was evaluated. Results: Overall, INI-R decreased from 13.7% in 2007 to 4.7% in 2017

Poster Abstracts

536 ANTIRETROVIRAL DRUG RESISTANCE IN PATIENTS RECEIVING CARE AT ETHIOPIAN HEALTH CENTERS Anton Reepalu, Dawit A. Arimide , Per Bjorkman, Patrik Medstrand Lund University, Lund, Sweden Background: We have previously reported high rates of virological suppression in patients starting antiretroviral treatment (ART) at Ethiopian health centers, with no impact related to concomitant tuberculosis (TB) therapy. We further investigated patterns of antiretroviral drug resistance during ART among these persons, with particular regard to the effect of TB on selection of drug resistance. Methods: Participants were identified from a cohort of 812 ART-naive adults at Ethiopian health centers (recruited 2011-2013). At inclusion into the cohort, all subjects were investigated for active TB. Sequencing was performed on plasma samples from subjects with viral load (VL) ≥500 copies/ml (cpm) at 6 and/or 12 months after ART initiation. Antiretroviral drug resistance (DRM) was defined as Stanford score ≥60 for NRTI and/or NNRTI. If DRM was detected, sequencing was also performed on samples obtained before ART initiation (pre-ART) to determine if DRM was acquired during ART. Logistic regression was used to investigate the association between concomitant TB and risk of acquiring DRM,

CROI 2019 201

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