467. Ethnicity Associated Disparities in Antiretroviral Resistance among Perinatally HIV Infected Children and Adolescents
Session: Poster Abstract Session: Pediatric HIV
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • poster_IDSA_2015.pdf (480.2 kB)
  • Background: Evidence demonstrating an association of ethnicity with the incidence rate (IR) of antiretroviral major resistance associated mutations (mRAM) in HIV infected adults has been presented.  We undertook this study to determine if a similar association exists for perinatally acquired HIV.

    Methods: We analyzed data from  perinatally HIV infected children on combined antiretroviral therapy (cART) who had had more than one mRAM genotype test during the study interval (1998-2009). We determined IR of mRAM by each ART class and express results as number of mRAM per 100 person-years and 95% confidence intervals. Antiretroviral drug class specific mRAM and triple class resistance were defined as the absence of a class specific mRAM in a first genotype test and its presence in a subsequent test.  The difference between the date of the first mRAM test and that of the first detection of a mRAM defined the interval to mRAM for each individual.

    Results: 66 children were included. The population was mainly female (57.6%), black (74.2%) with a media of follow up of 10.1 years (IQR 6.6-14.4); the age at the first genotype was 6.2 (2.19-9.68) years. At the time of detection of first mRAM most were viremic (4.1 log10), had near normal CD4 (27%) and 60 were in viral failure (defined as an HIV RNA ≥ 400 copies/ml). The overall IR mRAM was 32.4 per 100 PY IQR (18.8-61.2); which comprised 25.4 (14.0-45.8) NRTI, 11.1 (7.0-17.6) NNRTI; 11.6 (7.1-19.1) PI and 6.0 (3.4-10.6) for triple class resistance. When the data were parsed by ethnicity, Hispanics had the highest IRs of mRAMs and were the major contributor to the magnitude of our combine mRAM followed by blacks (Table 1).

    Conclusion: Our data provide evidence of differences of mRAM IRs between ethnicities where Hispanics had high rates of mRAM to NRTI, NNRTI and triple class resistance. Further studies are necessary to understand the interplay of ethnicity, social factors, linkage and retention in medical care with the emergence of antiretroviral resistance in pediatric infected populations.  

     

    NRTI

    NNRTI

    PI

    Triple class resistance

    Ethnicity

    N

    Events

    Person-years

     IR

    N

    Events

    Person-years

    IR

    N

    Events

    Person-years

    IR

    N

    Events

    Person-years

    IR

    Hispanics

    1

    1

    2.64

    37.84 (5.33-268.70)

    8

    4

    25.01

    16 (6.00-42.60)

    4

    1

    13.26

    7.53 (1.07-53.51)

    1

    1

    6.84

    10.50 (3.38-32.56)

    Blacks

    14

    9

    40.39

    22.27 (11.60-42.81)

    33

    14

    126.81

    11.03 (6.53-18.64)

    30

    15

    114.13

    13.14 (7.92-21.80)

    14

    9

    159.92

    5.62 (2.92-10.81)

    German Contreras, MD MSc1, Cynthia Bell, MS2, Gabriela Delbianco, MD2, Norma Perez, DO3, Matthew Kleinosky, BS2, Laura Benjamins, MD2, James R. Murphy, PhD4 and Gloria P. Heresi, MD4, (1)Pediatric Infectious Disease, UTHealth, Houston, TX, (2)University of Texas UTHealth, Houston, houston, TX, (3)Pediatrics, UT Health, Houston, TX, (4)Pediatric Infectious Disease, UT Health, Houston, TX

    Disclosures:

    G. Contreras, None

    C. Bell, None

    G. Delbianco, None

    N. Perez, None

    M. Kleinosky, None

    L. Benjamins, None

    J. R. Murphy, None

    G. P. Heresi, None

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