HYNES CONVENTION CENTER

Boston, Massachusetts
March 4–7, 2018

 

Conference Dates and Location: 
February 13–16, 2017 | Seattle, Washington
Abstract Number: 
478

HIV INTEGRASE GENOTYPIC TESTING AND RESISTANCE IN THE UNITED STATES—9 JURISDICTIONS

Author(s): 

Angela L. Hernandez1, M. Cheryl B. Ocfemia1, Neeraja Saduvala2, Alexandra Oster1, Walid Heneine1, Jeffrey A. Johnson1, Irene Hall1

1CDC, Atlanta, GA, USA,2ICF Intl, Atlanta, GA, USA

Abstract Body: 

In 2016, national drug resistance testing guidelines were updated to recommend providers include integrase (IN) genotypic testing at entry into HIV care if transmitted resistance to integrase strand transfer inhibitors (INSTI) is a concern. We used National HIV Surveillance System (NHSS) data to assess the prevalence of IN genotypic testing and INSTI-associated resistance.

We analyzed HIV-1 sequences from persons with HIV infection diagnosed through 2014 and reported to NHSS by December 2015 from 9 surveillance jurisdictions (Colorado, Connecticut, California [Los Angeles County], Michigan, New York, Philadelphia, South Carolina, Texas, and Washington). We describe (1) overall prevalence and timing of IN genotypic tests after HIV diagnosis (≤3 months and >3 months) by sex, age, race/ethnicity, transmission category, stage of HIV disease, population of area of residence at diagnosis, and antiretroviral use (ARV) at diagnosis, and (2) prevalence of INSTI-resistant associated mutations using the updated CDC HIV-1 surveillance mutation list.

We analyzed 14,468 IN sequences; 7,107 (49%) sequences were IN only. IN genotypic testing was more common among males, persons aged 20-29 years, blacks; by transmission category, more common among males with HIV infection attributed to male-to-male sexual contact, heterosexual females, persons who were not stage 3 of HIV disease (AIDS), and persons residing in areas with a population of >500,000. Prevalence of INSTI-resistant mutations among all IN sequences was extremely low (65/14,468; 0.4%). Of these, the most prevalent mutations were N155H (38%), followed by E92Q (29%) and G140S (25%). IN genotypic testing was performed ≤3 months after diagnosis for 5,240 (36%) persons, of which 4,631 (88%) had no evidence of ARV use; 2 (0.04%) had transmitted INSTI-associated resistance (N155H [100%]; E92Q [50%]).

INSTI-resistant mutations are rare and indicate that current INSTI-based regimens remain effective. A majority of genotypic testing for resistance to INSTIs occurs more than 3 months of HIV diagnosis likely after initiation of antiretroviral therapy. NHSS provides the opportunity to monitor IN genotypic testing and prevalence of INSTI-associated resistance at a population level.

Session Number: 
P-J1
Session Title: 
PREVALENCE AND INCIDENCE OF HIV DRUG RESISTANCE
Presenting Author: 
Angela Hernandez
Presenter Institution: 
CDC