1507. Application of GenoSure Archive© in Clinical Practice
Session: Poster Abstract Session: HIV Drug Resistance
Friday, October 28, 2016
Room: Poster Hall

Application of GenoSure Archive© in Clinical Practice

HK Singh MD, S Jones MD, C Vaamonde MD, T Wilkin MD

Background: Modification of antiretroviral (ARV) regimens among virally suppressed HIV positive patients in the absence of historical antiretroviral resistance data is challenging. In this setting, the GenoSure Archive (GA) can provide resistance data by amplifying HIV-1 DNA from plasma blood monocyte cells.  However, there is a paucity of data on the clinical utility of this test when choosing subsequent regimens.

Methods: We conducted a retrospective cohort study of all HIV positive adults with a GA while virally suppressed on ARVs (plasma RNA <200 copies/mL) at a large urban NYC clinic from 12/2014-12/2015. Demographic data, reasons for obtaining GA, pre and post ARV regimens and HIV parameters, and all available historical resistance studies were abstracted. ARV resistance mutations were based on IAS-USA mutations. We used descriptive calculations.

Results:  140 patients had a GA test, ( mean age 54 years (24-74), 27% female, mean duration  HIV infection 20 years (1-32), median 588 CD4 cells/mm3). 21% patients had viral blips (21-200 copies/ml), the rest were undetectable. 39% of patients had no available historical resistance records. Simplification (35%) was the main reason for obtaining GA, followed by verification of regimen (28%), side-effects (27%), and drug-drug interactions (10%). One-third of the GA results were wildtype, 24%, 24%, and 19% had 1, 2, and 3 class resistance, respectively. Concordance between the GA and historical genotypes is presented in Table 1. Of the 140 patients, 79 had post GA ARV regimen changes;   85% of those with available data remained undetectable at 3 months.

 

Conclusion: Use of the GA resulted in ARV switches in over 50% patients. GA has excellent concordance with historical genotypes and detected additional mutations as compared to historical resistance . GA is new useful tool in the management of HIV infection, but larger studies with viral outcome data are needed to determine the precision of its utility.

Table 1. Overall and Class Concordance.

 

NRTI

NNRTI

PI

All classes

any class

On GA only

17 (24.6%)

15 (21.7%)

12 (17.4%)

6 (8.7%)

25 (36.2%)

Concordance

50 (72.5%)

50 (72.5%)

53 (76.8%)

37 (53.6%)

63 (91.3%)

Not detected on GA

2 (2.9%)

4 (5.8%)

4 (5.8%)

0

8 (11.6%)

Note: n (%)

 


Harjot Singh, MD ScM1, Sian Jones, MD2, Carlos Vaamonde, MD2 and Timothy Wilkin, MD, MPH, FIDSA1, (1)Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, (2)Division of Infectious Diseases, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY

Disclosures:

H. Singh, Gilead: Scientific Advisor , Consulting fee

S. Jones, None

C. Vaamonde, None

T. Wilkin, Bristol-Myers Squibb: Grant Investigator , Research support
Gilead Sciences: Grant Investigator , Research support
Glaxo Smith Kline/ViiV: Grant Investigator , Research support

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