1083. Responses to first-line antiretroviral therapy (ART) in patients with isolated NNRTI transmitted drug resistance (TDR)
Session: Poster Abstract Session: HIV: Resistance
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IDWeek 2015 NNRTI TDR Outcomes.pdf (872.5 kB)
  • Background: Few data exist to inform the selection of first-line ART in patients with NNRTI-associated TDR.

    Methods: The population included HIV-1 infected, ART-naïve adults with major NNRTI drug resistance mutations (DRMs) initiating ART in Kaiser Permanente Northern California. DRMs were detected using standard genotypic resistance testing, and those with PI or NRTI DRMs were excluded. Medical and pharmacy records were reviewed to characterize the population and responses to therapy according to ART regimen. The primary outcome was virologic failure (VF) defined as either (i) failure to achieve HIV-1 RNA level below the limit of quantification within 24 weeks of ART; (ii) ART change before 24 weeks due to persistent viremia; or (iii) ≥2 consecutive HIV-1 RNA levels ≥200 copies/ml after suppression.

    Results: Of ~3,300 patients initiating first-line ART between April 2002 and May 2014, 137 (4.2%) had isolated NNRTI-associated TDR. 34 were excluded for either insufficient follow-up (28) or non-standard ART (6), and 103  were eligible for analysis. Patients were 86% male, median age of 40 years, with baseline CD4 count of 341. cells/mm3and baseline plasma HIV-1 RNA of 4.5 log10 copies/mL. 47% were treated with a PI, 42% with an INSTI and 11% with an NNRTI. The most common NRTI backbone was FTC/TDF (93%). The median duration of follow-up was 120 weeks. VF occurred in 14% of patients in the PI group, 7% in the INSTI group, and 36% in the NNRTI group (Table 1). Of the 10 patients with VF in the PI (7) and INSTI (3) groups, none failed with new DRMs, and 5 subsequently suppressed with no change in ART.

    Conclusion: Among patients with isolated NNRTI-associated TDR, response rates were high with PI- and INSTI-based regimens.

     

    Table 1. Follow-up and outcomes by ART regimen

    Class

    Drug

    n

    Median follow-up (weeks)

    VF (%)

    PI

    Atazanavir

    22

    230

    4 (18)

     

    Darunavir

    19

    118

    2 (11)

     

    Lopinavir

    8

    238

    1 (11)

     

    Total

    49

    159

    7 (14)

    INSTI

    Raltegravir

    28

    152

    1 (4)

     

    Elvitegravir

    15

    48

    2 (13)

     

    Total

    43

    96

    3 (7)

    NNRTI

    Rilpivirine

    4

    61

    2 (50)

     

    Etravirine

    2

    111

    0

     

    Efavirenz

    5

    34

    2 (40)

     

    Total

    11

    65

    4 (36)

    All

     

    103

    120

    14 (14)

    Dana Clutter, MD1, Jeffrey Fessel, MD2, Soo-Yon Rhee, MS1, Daniel Klein, MD2, Michael Silverberg, PhD, MPH2 and Robert Shafer, MD1, (1)Infectious Diseases, Stanford University, Stanford, CA, (2)Kaiser Permanente Northern California, Oakland, CA

    Disclosures:

    D. Clutter, None

    J. Fessel, None

    S. Y. Rhee, None

    D. Klein, None

    M. Silverberg, None

    R. Shafer, Roche Molecular: Grant Investigator , Research grant
    Gilead Sciences: Grant Investigator , Research grant
    BMS: Grant Investigator , Research grant
    Merck: Grant Investigator , Research grant

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