patients into two groups (group 1 1992 to 2006 N = 132; group 2 2007 to 2013
412. Predictors of Mortality in Persons Living With HIV in the Philippines: N = 892) to explore temporal trends coinciding with the widespread rollout of
The Impact of Widespread Antiretroviral Therapy and the Case for Early
Treatment
Edsel Maurice Salvana, MD, DTM&H, FIDSA1,2; Katerina Leyritana, MD2;
Marissa Alejandria, MD, MSc, FPCP, FPSMID2; Raul Destura, MD1; Patrick Ching,
MD2; Richmond Duque, BS2; Richelle Duque, MD2; Crizan Amor, BS2; Olivia Sison,
MS3; Jodor Lim, MD, FPCP, FPSMID2; 1Institute of Molecular Biology and
Biotechnology, National Institutes of Health, University of the Philippines, Manila,
Philippines; 2Department of Medicine, Section of Infectious Diseases, University of the
Philippines-Philippine General Hospital, Manila, Philippines; 3Department of
Epidemiology, University of the Philippines Manila, Manila, Philippines
Session: 60. HIV Engagement in Care and the Care Cascade
Thursday, October 8, 2015: 12:30 PM
Background. HIV infections in the Philippines have climbed >35-fold in the last
decade. The impact of widely available free antiretrovirals (ARVs), and earlier initia-
tion of treatment has not been conclusively demonstrated in this country. We looked at
temporal trends and predictors of mortality to better characterize the epidemic in the
Philippines, and provide clinical evidence of the beneficial effect of early and sustained
ARV therapy.
Methods. Following institutional board review approval, we retrospectively re-
viewed 1022 charts of patients aged ≥18 years at our HIV clinic at the Philippine Ge-
neral Hospital, one of the largest tertiary referral centers in the country. We divided
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ARVs. Multivariate analysis on the entire cohort was done to look at factors associated
with mortality.
Results. Age at diagnosis was significantly younger for group 2 compared to group
1 (mean = 29 versus 35 years, p < 0.0001). The proportion of males (96% versus 74%),
patients identifying as homosexual (50% versus 14%) or bisexual (37 versus 8%), sex
with multiple partners (93% versus 33%), and initial WHO stage 1 diagnosis (45% ver-
sus 14%) were all significantly higher in group 2 ( p < 0.0001). Median initial CD4 (193
versus 220 cells/µL) was not significantly different between groups. The ARV regimen
most used in group 1 was zidovudine, lamivudine, and nevirapine (65%), whereas te-
nofovir, lamivudine and efavirenz (40%) were the most common in group 2.
Factors associated with mortality for the entire cohort were a CD4 count at diagno-
sis < 200 cells/µL (OR 5.98, 95%CI 2.26-15.80, p < 0.0001); the use of efavirenz-based
ARV (OR 0.23, 95%CI 0.11-0.25, p < 0.0001) and use of nevirapine-based ARV (OR
0.34, 95%CI 0.15-0.76, p < 0.0001). Not enough patients were on a protease-inhibitor
regimen for adequate analysis.
Conclusion. The epidemiology of HIV in the Philippines has changed, with in-
creasing proportions of MSM with multiple sexual partners making up new cases. Pa-
tients are being diagnosed at younger ages with few symptoms, although CD4 counts
were not significantly different. Mortality is higher in patients diagnosed at lower CD4
counts, and ARVs have a significant impact on survival in Filipinos living with HIV.
Disclosures. E. M. Salvana, MSD: Speaker’s Bureau, Speaker honorarium
Poster Abstracts • OFID 2015:2 (Suppl 1) • S149