CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

surveillance and intervention programs to identify and fight these, sometimes massive, local outbreaks.

cases of this variant in our area and their epidemiological relationship with the previous ones. Methods: We considered NHIVD at Virgen de la Victoria Hospital, reference center in southern Spain, from 01/17 to 06/18. Drug resistance mutations were determined with Viroseq HIV® system and the partial sequence of HIV-1 pol gene provided submitted to REGA v3.0 for subtyping. Sequences assigned as CRF19_cpx subtype were phylogenetically compared to the 254 reference sequences of the same variant retrieved from the LANL, as well as to the 55 ones comprising the already described CRF19_cpx variant outbreak. The alignment was done by Clustal X and the phylogenetic reconstruction inferred by maximum likelihood method (PhyML v3.0 program). The cluster reliability was supported on the value of SH-like aLRT test. The resistance mutations were predicted using Stanford algorithm v7.1.1. Results: 523 resistance studies were performed in NHIVD; 13 (2.4%) had sequences consigned in REGA as subtype CRF19_cpx. All the new cases conformed a very well-defined transmission cluster (aLRT=92%) with the CRF19_cpx sequences from the previous outbreak, already comprising up to 67 patients. Eight of the new sequences were clustering within two subclusters previously defined: E and F, currently including 18 and 3 patients, respectively. We have not found the G190A mutation in any of the new sequences. The new cases of the CRF19_cpx were MSM, with an average age of 32.5 years (IQR: 27.1-43.6) and Spaniards, except one Italian patient. Half of themwere seroconverters, mean seroconversion time of 17.0 months, (8.3-81.3).The initial CD4 count was 423 cells/μL (200-562) and viral load was 4.9 log copies/mL (4.6-5.2). Conclusion: All the new cases of the CRF19_cpx variant emerged in our area during 2017 and half this year are phylogenetically clustered with the previous outbreak, pointing out its active status. The NHIVD infected with this variant possess similar epidemiological, clinical and immuno-virological characteristics to those already included in the outbreak. None of the new sequences of this subtype showed the G190A mutation. The active transmission of the CRF19_cpx variant in our area should warn us about the necessity of intense epidemiological surveillance programs.

868 WITHDRAWN / INTENTIONALLY UNASSIGNED 869 NEW GENOMES FROM THE CONGO BASIN EXPAND HISTORY OF CRF01_AE ORIGIN AND DISSEMINATION Eduan Wilkinson 1 , Ana Vallari 2 , Dennis Maletich Junqueira 1 , Carole McArthur 3 , Lazare Kaptue 4 , Dora Mbanya 5 , Gavin Cloherty 2 , Tulio de Oliveira 1 , Mary A. Rodgers 2 1 University of KwaZulu-Natal, Durban, South Africa, 2 Abbott Labs, Abbott Park, IL, USA, 3 University of Missouri–Kansas City, Kansas City, MO, USA, 4 University of Montagnes, Bangangté, Cameroon, 5 University of Yaoundé, Yaoundé, South Africa Background: Although the first HIV circulating recombinant form (CRF01_AE) is a predominant strain in many Asian countries, it is uncommon in the Congo basin where it first originated. Therefore, we sequenced CRF01 genomes from Cameroon and the Democratic Republic of Congo (DRC) to characterize the molecular history of CRF01. Methods: Near complete genomes were sequenced from N=13 specimens previously classified as CRF01 or CRF01-containing recombinants in the gag, pol, and/or env, regions through viral surveillance studies conducted in Cameroon and DRC between 2001-2006. Random primed libraries spiked with HIV specific primers were sequenced on an Illumina HiSeq and genomes were assembled using CLC Bio. Genome sequences were aligned to reference strains, including Asian and African CRF01 sequences, and evaluated by maximum likelihood phylogenetic inference (RaXML), REGA subtyping, jpHMM, Simplot, Sequence Signature Visual Analysis, and BLAST. The CRF01_AE evolutionary history was inferred with a Bayesian SkyRide coalescent tree prior under an uncorrelated lognormal relaxed clock assumption using BEAST v1.8.4. Results: The spiked primer next generation sequencing method produced 8 HIV genomes (8800-9586 nucleotides (nt) long) with full coverage and 5 genomes with 95-98% coverage, which were completed with Sanger sequences. Phylogenetic and recombinant analyses identified 4 pure CRF01, 2 CRF02, 1 CRF27, and 6 unique recombinant form (URFs) genomes (01|A1|G, 01|02|F|U, F|G|01, A1|D|01, F|G|01, A1|G|01). All recombinants described in this study included at least 1000 nt long portions classified as CRF01. In Bayesian analysis of the pure CRF01 genomes, three reference CRF01 genomes isolated in the Congo Basin were basal to the Cameroon/DRC clade branch. Molecular dating indicates that the most recent common ancestor of this clade emerged around 1972 [95% Bayesian credible interval (BCI): 1970-1974] in the Congo basin. The Asian expansion of CRF01 started after 1976 (95% BCI: 1975-1978). Conclusion: Full genome characterization is required to identify pure CRF01 strains since recombination was high amongst strains from the Congo basin. The complex patterns of recombination described here suggest that ancestral CRF01 sequences are circulating in the region within recombinant forms. Corroborating previous reports, phylogenetic analyses with the new pure CRF01 genomes indicated that CRF01 originated in the Congo Basin around 1972 and spread beyond Africa around 1976. 870 PERSISTENT OUTBREAK OF THE HIV-1 CRF19_CPX VARIANT IN TREATMENT-NAIVE MSM PATIENTS Isabel Viciana 1 , Carmen M. González Domenech 1 , Cristina Gomez-Ayerbe 1 , Marisa Mayorga 2 , Javier De La Torre Lima 3 , Manuel Castaño 2 , Rosario Palacios 1 , Jesus Santos 1 1 Hospital Virgen de la Victoria, Málaga, Spain, 2 Hospital Regional Carlos Haya, Malaga, Spain, 3 Hospital Costa del Sol, Marbella, Spain Background: During the period 2011-2016, the HIV-1 CRF19_cpx variant emerged as an outbreak in newly HIV diagnosed (NHIVD) in southern Spain. Our aimwas to determine the current status of this outbreak, analyzing the new

Poster Abstracts

CROI 2019 338