388. Transmitted Drug Resistance and HIV Molecular Epidemiology in Nicaragua
Session: Poster Abstract Session: HIV Epidemiology: HIV Drug Resistance - Molecular Epi and Transmission
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • POSTER IDWEEK 2015 DEFINITIVO.pdf (436.4 kB)
  • Background:  HIV Transmitted Drug Resistance (TDR) prevalence and trends, as well as HIV molecular epidemiology in Nicaragua are unknown. Knowledge on HIV TDR is important both for therapeutic decision-making and to establish public health policies on antiretroviral treatment (ART). We present results on the first study to determine HIV TDR and molecular epidemiology in Nicaragua.

    Methods:  HIV-infected ART-naïve individuals from Nicaragua were enrolled from 2011 to 2014. Blood samples were collected at Hospital Roberto Calderón in Managua and sent to the Centre for Research in Infectious Diseases in Mexico City, a WHO accredited laboratory, to be processed. HIV pol sequences were obtained by the Sanger method, using an in-house assay. HIV subtyping was performed with REGA Subtyping Tool v2 and RIP 3.0, available on line. TDR was assessed using the WHO TDR surveillance mutation list.

    Results: A total of 235 individuals were enrolled in the study. The median age was 32 years (IQR 26-40). The median viral load was 4.8 log RNA copies/mL (IQR 4.2-5.4) and the median CD4+ T cell count was 310 cells/mm3 (IQR 111-462), reflecting earlier median times for presentation to clinical care in Nicaragua compared with other Latin American countries. During the study period the overall TDR prevalence was 12.3% (95% CI 8.4-17.2%). A higher TDR prevalence was found for NRTI (6.0%,  95% CI 3.3-9.8%) and NNRTI (5.5%, 95% CI 3.0-9.3%) compared to PI (1.7%, 95% CI 0.5-4.3%, p<0.05). Individuals using IV drugs were more prone to present TDR (OR 11.8, 95% CI 1.9-73.8, p=0.01) and individuals with TDR had higher CD4+ T cell counts than individuals without TDR (p=0.04).  No other demographic or clinical variables were associated with TDR. No significant temporal tendencies were observed in TDR during the study period.  The most frequent TDR mutations were M41L for NRTI, K103N for NNRTI, and M46IL for PI. A cluster of viruses with NRTI TDR from men who have sex with men was observed. Subtype B was the most prevalent (98.3%) and non-B subtypes included BD (1.3%) and BF1 (0.4%) viruses.

    Conclusion:  The global TDR prevalence in Nicaragua –according to the WHO classification- is at the intermediate level.  Resistance to NRTI was the most frequent. Although no temporal trends in TDR were observed, further TDR surveillance studies with better representativity are warranted in the country.

    Santiago Avila-Ríos, PhD1, Claudia García-Morales, MSc1, Daniela Tapia-Trejo, QFB1, Guillermo Porras-Cortés, MD2, Carlos Quant-Durán, MD3, Sumaya Moreira-López, MD2, Bismarck Hernández-Alvarez, CB3 and Gustavo Reyes-Terán, MD1, (1)Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico, (2)Hospital Metropolitano Vivian Pellas, Managua, Nicaragua, (3)Hospital Roberto Calderón, Managua, Nicaragua

    Disclosures:

    S. Avila-Ríos, None

    C. García-Morales, None

    D. Tapia-Trejo, None

    G. Porras-Cortés, None

    C. Quant-Durán, None

    S. Moreira-López, None

    B. Hernández-Alvarez, None

    G. Reyes-Terán, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.