1084. Pre-switch Resistance to Complera and Stribild and its Impact on HIV Virological Outcome
Session: Poster Abstract Session: HIV: Resistance
Friday, October 9, 2015
Room: Poster Hall
Posters
  • Poster_1084.pdf (960.8 kB)
  • Background: Convenient one-pill-once-a-day regimens (OPODs) like Complera and Stribild appeal to providers and patients. Data on impact of resistance to these drugs on treatment outcomes are important yet limited, particularly in treatment experienced patients.

    Methods: In the largest HIV Center in Rhode Island, we identified patients switched to Complera or Stribild that had pre switch genotypes containing significant resistance (defined as low, intermediate or high level by Stanford Database scores) to any component of the two OPODs, and evaluated their viral load (VL) outcome 12 months post switch.

    Results: Of 1,624 Center patients, 128 (8%) switched to Complera (56; 3%) or Stribild (72; 4%) and had pre switch genotypes. Significant resistance was seen in 38/128 (30%) based on the closest pre switch genotype (12 Complera, 26 Stribild); and 43/128 (34%) based on accumulated pre switch genotypes (12 Complera, 31 Stribild). Mean age at switch for the 43 patients was 46 years; 58% were female; mean exposure to 9 drugs/patient; mean CD4 469 cells/μL; mean VL 152,903 copies/mL (49% suppressed at switch). Switch reasons were adherence (42%), pill burden (40%), side effects (16%) and resistance (2%). Common accumulated Complera-associated mutations were M184V (emtricitabine, 8/12, 67%), K65R (tenofovir, 1/12, 8%) and L100I (rilpivirine, 3/12, 25%); and Stribild-associated mutations M184V (29/31, 94%) and K65R (6/31, 19%). At 12 months, 27/43 (63%; 7/12, 58% on Complera; 20/31, 65% on Stribild) patients achieved VL suppression (≤ 200 copies/mL), despite high (89%), intermediate (4%) or low (7%) level accumulated resistance to ≥1 OPOD component. Of 27 patients with VL suppression only 5 (19%) had M184V alone. Of 16 without VL suppression, 8 (50%) had M184V alone (p=0.03; Chi Square). Adherence challenges were documented in 22/43 (51%) after the switch, 8 (36%) with VL suppression. Conversely, 90% (19/21) of adherent patients (5 Complera, 16 Stribild) achieved suppression (p<0.0001; Chi Square Test).

    Conclusion: In this short term study, 12 month VL suppression to Complera or Stribild was high, particularly with good adherence, suggesting that these OPODs remain good options even for treatment experienced patients with pre switch accumulated resistance.

    Rebecca Reece, MD1, Matthew D'antuono, BS2, Karen Tashima, MD1 and Rami Kantor, MD1, (1)Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, (2)Immunology, Brown University, Providence, RI

    Disclosures:

    R. Reece, None

    M. D'antuono, None

    K. Tashima, None

    R. Kantor, None

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