1270. HIV Drug Resistance and Viral Outcomes after 2nd-line Antiretroviral Failure in Kenya

Abstract Background Program data on HIV drug resistance and clinical outcomes after 2nd-line antiretroviral therapy (ART) failure in resource-limited settings are limited, yet can inform care, particularly with better ART access options. Methods We examined upon subsequent viral at the Academic Model Providing Access to Healthcare (AMPATH) Kenya. Charts of people genotypes up 6/2021 were reviewed; associations suppression (< 1000 copies/mL) closest 12 months post-genotyping determined using bi- multivariate analyses, adjusting for age, sex, time ART, switch 3rd-line (darunavir-, dolutegravir-, and/or raltegravir-based ART), any regimens load (VL) testing. Results Of 194 participants (53% female; median age 41 years; 3.3 4.1 years 1st- 2nd-line), 60% lopinavir/ritonavir 40% atazanavir/ritonavir-based regimens. Overall, 178 (92%) had resistance: 19% mono-, dual-, 41% triple-class; 79% NRTIs; 81% NNRTIs; 43% PIs - 33% those lopinavir/ritonavir; 58% atazanavir/ritonavir (p< 0.001); 24% intermediate-high predicted darunavir/ritonavir (12 LPV/ritonavir, 8 failure; p=0.98). 140/194 post-genotype VLs, 55% stayed 2nd-line, 45% switched 3rd-line. 140, 72% virally suppressed (89% who 3rd-line; didn't), 75% their regimen VL (90% 62% didn't). In bivariate analysis, was associated switching 3rd-line, testing (Table). remained more likely among association less pronounced. Conclusion a large Kenyan program, high failure, rates, suggest need dedicated management this vulnerable population. Potential between outcomes, similar reports 1st-line needs further suggests significance inadequate adherence. Disclosures All Authors: No reported disclosures.