1257. Antiretroviral treatment failure in a prospective cohort of Persons Living with HIV in the Philippines

Abstract

Abstract Background Widespread access to antiretrovirals has resulted in improved survival among PLHIV in resource-limited settings. In a previous study, ART failure in the Philippines after one year was found to be 10.3%. However, this was done as a cross-sectional study and did not capture dropouts or pre-existing drug resistance (PDR). Treatment failure, taking into account PDR, dropouts, and long-term viral suppression has not been studied. As part of a transmitted drug resistance (TDR) study, we prospectively followed patients and documented long-term viral suppression. Methods We enrolled 227 treatment-naïve PLHIV without TDR on Sanger-based sequencing and measured viral load (VL) every 6 months. VL “>”1000 copies/mL after initiation of treatment was considered treatment failure. An intention to treat analysis counting loss to follow-up as treatment failure was performed along with secondary analysis by subtype. Results Treatment failure at different time points are shown in Table 1. Of the 227 patients, 177 were subtype CRF01_AE, 30 were B, 14 were CRF01_AE/B recombinants, 2 were subtype CRF02_AG, 2 were CRF01_AE/B/F recombinants and one was an A1/D recombinant. Median VL was 295,000 copies/mL at baseline (range: 40 - 658,000 copies/mL). Seventeen PLHIV developed treatment failure over an observation time of up to 60 months, while 74 were lost to follow-up. Comparison between B and non-B subtypes showed a higher rate of failure among non-B subtypes (OR 2.868 95% CI 1.018 to 10.016 p=0.0380) at one year, but this was no longer significant at 24 months (p=0.1534) and 48 months (p=0.0716). Conclusion HIV viral suppression at one year of treatment is 65.6% in an intention to treat analysis. It is 63.4% at 24 months and 60.8% at 48 months. Excluding dropouts, viral suppression is 95.5%, 92.3%, and 89.0% at 12, 24, and 48 months, respectively. Non-B subtypes are more likely to fail than those with B subtypes in the first year of treatment. Loss to follow-up is a significant problem in the Philippines and needs to be addressed proactively in order to improve local efforts to reach the 90-90-90 thresholds of UNAIDS for control of HIV in the country. Disclosures Edsel Maurice Salvana, MD, MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria.