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BackgroundThe Philippines has the fastest-growing HIV epidemic in the Asia-Pacific. Concurrent sexually-transmitted infections increase the risk of HIV transmission and complications. The prevalence of Neisseria gonorrheae (NG) and Chlamydia trachomatis (CT) infection among Filipino HIV patients is unknown and screening is not universal. A symptom-based approach likely underestimates the prevalence of NG and CT among men who have sex with men (MSM). We determined the rectal, pharyngeal, and urethral prevalence of gonorrhea and chlamydia infection in our patient population using nucleic acid testing (NAT).MethodsThis is a single-center, prospective cross-sectional study at Philippine General Hospital. Following ethical approval and informed consent, pharyngeal, rectal, and urine samples from newly-diagnosed, treatment-naïve HIV adult patients were tested using the Xpert® CT/NG assay (Cepheid, Sunnydale, CA). Patients with recent (≤21 days) antibiotic use with activity against NG or CT were excluded. Demographic and clinical data were also collected.Results46 subjects were enrolled. Mean age was 31 years (range 19–49), 83% (38/46) were male, 96% (44/46) were asymptomatic, and 92% (35/38) of the males were MSM. Median CD4 count was 225 cells/μL (range 0–1,335). The overall prevalence of CT/NG was 33% (15/46). Table 1 shows the prevalence of CT and NG by site. Four patients had both genital and rectal CT. More patients had rectal NG/CT compared with urethral and pharyngeal sites. No gonorrhea was found in the urine specimens; no chlamydia was found in the pharynx.ConclusionThe prevalence of CT and NG among newly diagnosed Filipino HIV patients at 33% is sufficiently high to warrant routine NAT screening. Urine testing alone will miss a significant number of cases in an MSM-predominant population. We recommend NAT screening of both urethral and rectal sites for newly-diagnosed Filipino HIV patients. Disclosures All authors: No reported disclosures.

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.