CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

906 SIX YEARS OF INTEGRASE INHIBITOR USE IN A METROPOLITAN CITY B. Sharmila Mohanraj 1 , Qingjiang Hou 2 , Anne K. Monroe 3 , Princy Kumar 1 , Seble Kassaye 1 , for the DC Cohort Executive Committee 1 Georgetown University, Washington, DC, USA, 2 Cerner Corp, Kansas City, MO, USA, 3 George Washington University, Washington, DC, USA Background: Integrase strand-transfer inhibitors (INIs) have excellent efficacy, safety, tolerability and ease of dosing and are now part of first-line therapy in the U.S. We investigated trends in INI use in the District of Columbia (DC), an area with 1.9% HIV prevalence, to determine INI treatment effectiveness outside of clinical trials. Methods: We conducted a retrospective analysis using data from the DC Cohort, a clinical cohort of HIV-infected persons receiving care at thirteen academic and community-based treatment sites in DC. We used descriptive statistics to determine the incidence of INI resistance and durability of viral suppression (two consecutive viral loads <200 c/mL). Drug resistance was defined using the International Antiviral Society-USA classification system. All analyses were conducted using SAS (v9.4.2). Results: Among 6827 participants, 73%were male, 78% Black, and median age was 47 years (IQR:37.1-54.7). INI-based therapy increased from 23% (582/2490) in 2011 to 64% (3783/5898) in 2017, when 52% of total participants on INIs used dolutegravir. From 2011 to 2017 INI resistance was identified in only 1% (38/3783) of participants. Major mutations included Q148H/R (n=11), N155H (n=5), F121Y (n=4), Y143H/R (n=3), and G140S (n=3). Nine individuals had baseline INI resistance mutations. The mean time to suppression was 163 days among non-suppressed treatment-experienced persons starting their first INI regimen and 127 days for treatment-naive persons starting an INI regimen (p=0.003). Viral suppression at 6 months was similar between these groups, 70% among non-suppressed treatment-experienced individuals switching to INI regimen vs 76% among treatment naïve individuals initiating INI-based therapy (p=0.116). Rebound viremia after suppression was most frequent in the first year post INI initiation at 6.6% (158/2403) [Figure 1], and was least frequent for treatment-naïve persons. Conclusion: The majority of participants in the DC Cohort are now on INI-based therapy. INI resistance remains rare. Long term viral suppression is evident among treatment naïve individuals starting INI-therapy, but remains a challenge for those with evidence of viremia on prior treatment regimens. Adherence likely plays a significant role, and increased attention to treatment outcomes and support measures should be in place during the first year of INI-based therapy as the risk for viremia appears to be greatest during this time period.

905 RESUPRESSION IN 1ST-LINE ART PATIENTS KENYA: DOES ART LONGEVITY AFFECT RESUPPRESSION? Christabel Orera Bodo 1 , Kariithi Edward 1 , Osiemo Dennis 1 , Crandall Bud 1 , Kinyua Eunice 1 , Elizabeth Mgamb 2 , Jack Magara 2 , Eliza Owino 2 , Abel Omao 2 , Millicent Ongidi 2 , Richard Onkware 2 , Diana Odhiambo 1 , Dominic Mutai 1 , Catherine Bonde 1 , Nick Odiyo 1 1 PATH, Seattle, WA, USA, 2 Ministry of Health, Nairobi, Kenya Background: As we enter the third decade of HIV/AIDS, more people living on lifelong ART (Antiretroviral therapy) are facing threats to HIV drug resistance (HIVDR) and subsequent treatment failure. World Health Organization 2016 recommended ART initiation for all HIV patients and use of viral load in monitoring treatment response. Kenya adopted these recommendations as part of the guidelines in the same year; which led to a rapid scale-up of ART uptake and viral load testing among HIV patients. Access to viral load testing presents opportunities for early detection of treatment failure and mitigating HIVDR, which is imperative in improving outcomes especially for treatment experienced patients who have been on ART longer. This study aims at determining if there are associations between the duration on ART and resuppression in HIV patients on first line regimen. Methods: Data from 32 high volume facilities in western Kenya was extracted from the National EID/VL website, for patients with recorded high VL (>1000 Copies) in the period of October 2016 - 2017. Additional data was abstracted from patient records and high VL follow up register on the number of enhanced adherence counselling done, patients ART history, viral load, and patient’s demographics. We used STATA version 13 for the statistical analysis, which included descriptive and bivariate analysis of years on ART and viral load suppression Results: The sample had 1,636 patients who had been on ART for ≥ 6 years, 66%were females, 60%were adults aged between (20-49yrs), 21%were older patients aged (≥50 years), 18%were pediatrics and adolescents, Median age was 34 years (IQR: 24 - 43). Common ART regimen was TDF/3TC/EFV (39%) and AZT/3TC/NVP (28%). Ages between (15-19) years and (10-14) years had poorer resuppression rates 18.6% and 26% respectively. Overall resuppresion was 42%with males having 31% as compared to females who had 69%. There is an association between duration on ART and viral resuppression, and significance in the duration between (1-2) years (OR 0.70, 95% CI: 0.57 – 0.84), (4-6) years (OR 1.22, 95% CI: 1.05 – 1.43) and > 6 years (OR 1.35, 95% CI: 1.2 – 1.52) Conclusion: Longevity on ART increases the risk of failing treatment, pediatrics, adolescents and men are at a higher risk of failing treatment. We need to optimize the use of newer highly efficacious regimens such as dolutegravir, and develop or customize the adherence counselling systems offered to patients who are maturing on ART to improve outcomes.

Poster Abstracts

CROI 2019 353