1368. HIV Transmitted Drug Resistance in the Philippines: The Case for Baseline Genotyping and Drug Resistance Testing
Session: Poster Abstract Session: HIV Drug Resistance
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • Salvana TDR Poster 1368 v2.pdf (599.9 kB)
  • Background: The Philippines has one of the fastest growing HIV epidemics in the world. Parallel to the increase is a shift in HIV subtype from B to CRF01_AE. No transmitted drug resistance (TDR) surveillance has ever been conducted. With the widespread rollout of antiretrovirals and the limited repertoire of 6 drugs (tenofovir, lamivudine, zidovudine, nevirapine, efavirenz, lopinavir/ritonavir) makes TDR monitoring imperative. In addition, a high rate of hepatitis B (HBV) co-infection (17%) in the general population raises the risk of TDR with prior NRTI monotherapy.

    Methods: Following IRB approval, we performed TDR surveillance at the Philippine General Hospital, one of the largest tertiary referral centers in the country. Treatment-naïve patients had their HIV RT and PR genes sequenced using WHO approved-protocols for HIV genotyping. Generated sequences were analyzed using the Stanford Drug Resistance Database. Pertinent demographic and clinical data were collected. The current results represent year 1 of the study.

    Results: 95 treatment naïve patients were analyzed. Median age was 30 years (range 20-68). There were 88 males and 7 females. Median CD4 count was 90 cells/mL (range 0-936) and median viral load was 1792000 copies/mL. 18 patients were co-infected with HBV, but all denied previous HBV treatment.

    Six samples were found to have drug resistance mutations:

    Sample

    Age

    Sex

    CD4 (cells/mL)

    Genotype

    Mutation

    02-010

    25

    M

    556

    AE

    Y181C

    02-020

    28

    M

    442

    AE

    E138G

    02-030

    31

    M

    197

    AE

    E138G

    02-033

    40

    M

    81

    AE

    T215A

    02-044

    22

    M

    526

    AE

    M184V, G190A

    02-082

    68

    M

    40

    AE

    Q58E

    Distribution of subtypes and recombinants are as follows: CRF01_AE=78, B=9, CRF01_AE/B=4, CRF01_AE/F1/B=2, CRF02_AG= 1, CRF01_AE/CRF15_01B=1 (Figure 1).

    Multivariate analysis with various factors did not show any significant associations predicting TDR, likely because of the low number of patients with resistance mutations.

    Conclusion: The TDR rate for HIV in the Philippines is 6.3%. This is above the threshold for recommending baseline TDR genotyping for all local HIV patients. All HIV with TDR were subtype CRF01_AE, and this may signal a higher risk of TDR as the epidemic shifts further to a non-B subtype.

    Figure 1. Phylogenetic tree showing CRF01_AE with little clustering whereas B is highly clustered.

    HIVTREECIRCLE(1)

    Edsel Maurice Salvana, MD, DTM&H, FIDSA1,2,3, Brian Schwem, PhD1, Christine Penalosa, MD2, Geraldine Arevalo, BS1, Nina Dungca, MS1, Jodor Lim, MD, FPCP, FPSMID4, Katerina Leyritana, MD2 and Raul Destura, MD1,2,3, (1)Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines (UP-NIH), Manila, Philippines, (2)Department of Medicine, Section of Infectious Diseases, University of the Philippines - Philippine General Hospital, Manila, Philippines, (3)Philippine Genome Center, Quezon City, Philippines, (4)Section of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines

    Disclosures:

    E. M. Salvana, Merck: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium

    B. Schwem, None

    C. Penalosa, None

    G. Arevalo, None

    N. Dungca, None

    J. Lim, None

    K. Leyritana, None

    R. Destura, None

    See more of: HIV Drug Resistance
    See more of: Poster Abstract Session
    Previous Abstract | Next Abstract >>

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.