413. Durability of Antiretroviral Therapy and HIV-1 RNA Resistance Mutations Among HIV-Positive Children in Tanzania
Session: Poster Abstract Session: Pediatric HIV
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 413_IDWPOSTER.pdf (803.0 kB)
  • Background: In Tanzania, HIV-positive patients are monitored by immunologic (CD4) and clinical criteria.  HIV-1 RNA testing is rarely available and not standard of care.  Determining antiretroviral therapy (ART) failure is challenging and resistance mutations accumulate compromising second-line therapy.  We evaluated virologic outcomes of a pediatric cohort over four years using resistance data and physician reported adherence to predict ability to suppress virus on protease inhibitor (PI) second-line ART.

    Methods: This is a prospective, cross-sectional cohort study with retrospective chart review evaluating HIV-positive Tanzanian children enrolled in 2008-2009 with repeat HIV-1 RNA in 2012-2013.   Demographic, clinical, and laboratory data including past CD4, viral load, and genotype were extracted from charts.  Resistance mutations were analyzed using the Stanford University HIV Drug Resistance database.  Statistical analyses were performed using Stata 12.1.

    Results: Of the original cohort, HIV-1 RNA were available for 122 children (5 died, 7 transferred, 22 lost to follow up, 50 awaiting viral load). (See Table)

    Resistance data were available for 28/41 (68%) originally failing first-line therapy.  Mutations included:  nucleoside reverse transcriptase inhibitors (NRTI), M184V 25/28 (89%); thymidine analogue mutations (TAMs) 14/28 (50%) including T215F/Y (36%), M41L (14%), L210W (7%); non-NRTI (NNRTI) 25/28 (89%) including K103N (46%), Y181C (21%).  Intermediate resistance was predicted in 9/28 (32%) patients of whom 4/9 (44%) fully suppressed.  Among the 5/9 still failing, 2 remain on first-line regimen and 2 had poor reported adherence.  One patient had high predictive resistance, but was able to fully suppress with good adherence.

    Conclusion: The majority of patients achieved virologic suppression despite multiple resistance mutations.  Improved understanding of virologic outcomes in resource-limited settings is critical for maximizing durability of ART.

    Original HIV-1 RNA Results

    2008 - 2009

    Follow Up HIV-1 RNA Results

    2012-2013

    Viral Load

     

    Total

    N (%)

    2nd line

    N (%)

    Viral Load

    Total

    N (%)

    2nd Line

    N (%)

    Suppressed

    < 400 copies/mL

    81 (66%)

    9 (12%)

    Suppressed

    69 (85%)

    9 (13%)

    Not Suppressed

    12 (15%)

    6 (50%)

    Not Suppressed

    > 400 copies/mL

    41 (34%)

    0 (0.0%)

    Suppressed

    29 (87%)

    29 (100%)

    Not Suppressed

    12 (13%)

      8 (67.8%)

    Dorothy Dow, MD, MScGH1,2, Aisa Shayo, MD2, Coleen Cunningham, MD1 and Elizabeth Reddy, MD2,3, (1)Pediatrics, Duke University Medical Center, Durham, NC, (2)Kilimanjaro Christian Medical Centre, Moshi, Tanzania, (3)Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC

    Disclosures:

    D. Dow, None

    A. Shayo, None

    C. Cunningham, None

    E. Reddy, None

    See more of: Pediatric HIV
    See more of: Poster Abstract Session

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.