970. Transmitted Antiretroviral Drug Resistance Over a Period of 11 years at a Single Center in Southeast, USA

Abstract

BackgroundIn the United States, the prevalence of TDRMs is approximately 20%. As newer agents have become available, INSTI-based therapies have become the standard first-line treatment. The objectives of this study were to: (1) examine the incidence of TDRMs during 2008-2019 at a single institution and, (2) examine the association between TDRM and year as well as type of therapy.MethodsA retrospective chart review was conducted at a single center in the Southeast United States. Resistance was defined on the basis of the International AIDS Society 2019 definition and Stanford University’s HIV Drug Resistance Database. Relative risk and multivariable logistic regression were used to analyze data.ResultsAmong 456 treatment-naïve patients who entered care 2008-2019 (80% male, 86% African American, mean CD4 count 359 cells/mm3), the cumulative incidence rate of >1 TDRM was 19.3% (n=88). There has been a steady increase in annual cumulative incidence in TDRMs since 2008, with the highest incidences in 2018 (46,667/100,000) and 2019 (36,585/100,000). Over the 11-year study period NNRTI resistance was most common (67/88; 76%), followed by NRTI (9/88; 10%), PI (4/88; 5%), and INSTI (2/88; 2%). Dual class resistance was noted in 6 (7%) patients, one of whom had TDRMs in the INSTI and NNRTI classes. The relative risk (RR) for TDRMs was 1.76 (95% CI=1.42-2.17). According to the regression model, compared to patients whose initial treatment was NNRTI-based, patients who started treatment on PI-based therapies (OR=5.34, 95% CI=2.17-13.11) or INSTI-based therapies (OR=4.00, 95% CI=1.43-11.20) had significantly greater odds of TDRMs, controlling for age, gender, race, baseline CD4+ count, HIV RNA, hepatitis B status, hepatitis C status, and time period of testing. The time period was not significantly related to TDRM incidence in this model.TDRM Incidence 2008-2019 ConclusionThe overall incidence of TDRMs in our clinic mirrors national surveillance data, with notably higher incidences in the last 2 years. Prescribing of the newly available INSTI-based regimens reflects the continued increase in the incidence of NNRTI TDRMs.Disclosures All Authors: No reported disclosures