Primary HIV-1 infection in users of pre-exposure prophylaxis

Ambrosioni, Juan; Petit, Elisa; Liégeon, Geoffroy; Laguno, Montserrat; Miró, José M.

doi:10.1016/s2352-3018(20)30271-x

Cited by 32 publications

(30 citation statements)

References 62 publications

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“…We confirm high rates of acquired viral resistance to emtricitabine, mostly in the form of M184V/I mutation, harboured in almost a third of these cases. Resistance mutations to PrEP components is predominately acquired through unrecognized or delayed HIV seroconversion before PrEP start, with the development of resistance observed in 45.8% of cases and higher prevalence among those who are adherent to PrEP [ 7 ]. A less common pathway for PrEP failure and resistance development is through HIV breakthrough due to sub-optimal PrEP adherence, which is believed to lead to resistance in about 5% of cases [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…HIV seroconversion in PrEP users is infrequent and its prevalence has been estimated at around 3% [ 7 ], with most PrEP ‘failures’ attributed to poor adherence. Less frequently, HIV breakthrough infections have been observed in those with good adherence to PrEP where the individual was already HIV positive but undiagnosed at PrEP initiation or even more rarely, due to the transmission of a HIV strain carrying resistance to PrEP components [ 7 ]. HIV seroconversion in individuals taking PrEP may be delayed [ 8 ], making the diagnosis of HIV challenging and on-going PrEP exposure in these individuals could lead to the development of HIV drug-resistance mutations [ 7 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Less frequently, HIV breakthrough infections have been observed in those with good adherence to PrEP where the individual was already HIV positive but undiagnosed at PrEP initiation or even more rarely, due to the transmission of a HIV strain carrying resistance to PrEP components [ 7 ]. HIV seroconversion in individuals taking PrEP may be delayed [ 8 ], making the diagnosis of HIV challenging and on-going PrEP exposure in these individuals could lead to the development of HIV drug-resistance mutations [ 7 , 9 ]. Given the paucity of data on the management of patients in this setting, we analysed the proportion of individuals reporting recent exposure to PrEP at HIV diagnosis over time and reported data on possible reasons for PrEP failure, baseline genotypic resistance and their clinical management.…”

Section: Introductionmentioning

confidence: 99%

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Rising rates of recent preexposure prophylaxis exposure among men having sex with men newly diagnosed with HIV: antiviral resistance patterns and treatment outcomes

Girometti

McCormack

Tittle

et al. 2021

Aids

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Introduction: Preexposure prophylaxis (PrEP) is contributing to achieve a reduction in HIV diagnoses in men having sex with men (MSM). Albeit infrequent, HIV infections in the context of recent PrEP exposure represent a clinical challenge.Methods: Data on recent PrEP use and possible reasons leading to HIV infection were analysed in individuals newly diagnosed with HIV at 56 Dean Street clinic in 2016-2020. Demographics, immune-virological parameters, genotypic resistance test results and treatment management in this group were compared with those not reporting recent PrEP exposure using Mann-Whitney U test and Fisher's exact test.Results: Fifty-two of 1030 (5%) individuals reported recent PrEP exposure at HIV diagnosis; 98% were MSM, median age 34 years (interquartile range [IQR] 28-42), 65% of white ethnicity, 65% non-UK-born. 35% reported PrEP intake the day before testing HIV positive, 46% reported sub-optimal PrEP adherence since their last negative HIV test result. Thirty-three of 52 (63%) were self-sourcing PrEP and 9/52 (17%) reported issues with its supply. Recent PrEP use was associated to lower HIV viral load and higher CD4 þ cell count at baseline than in counterparts non-recently exposed to PrEP (P < 0.01). M184V mutation was harboured more commonly in the recent PrEP use group (30% vs. 1%, P < 0.01). The proportion of individuals recently exposed to PrEP among those diagnosed with HIV rose sharply, reaching 21% in the first semester of 2020. Viral suppression was achieved by all patients intensified from PrEP to antiretroviral treatment (ART) who remained in care at week 24.Discussion: Rapid PrEP intensification to ART allowed to achieve high rates of HIV viral suppression despite significant rates of M184V mutation harboured in those newly diagnosed with HIV and reporting recent PrEP exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rising rates of recent preexposure prophylaxis exposure among men having sex with men newly diagnosed with HIV: antiviral resistance patterns and treatment outcomes

Girometti

McCormack

Tittle

et al. 2021

Aids

View full text Add to dashboard Cite

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“…[ 14 15 ] A reduction of 92% in the likelihood of infection has been proven when used correctly and in a controlled manner in persons with an increased risk. [ 16 17 18 ]…”

Section: Introductionmentioning

confidence: 99%

Basic knowledge among GP trainees regarding HIV pre- and post-exposition-prophylaxis

Flössner

Avetisyan

Frese

2021

J Family Med Prim Care

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Introduction: Preventing human immunodeficiency virus (HIV) infection is central to containing the HIV pandemic. For pre- and post-exposure prophylaxis (PrEP and PEP), drugs approved in Germany are available. Basic information on this should be obtained from physicians in further training to become specialists in General Practice (GP) since they may have to deal with this topic of high relevance for the health of patients at risk and also the physicians’ health after a possible exposure in the professional context. Methodology: A multiple-choice questionnaire was handed out to doctors in further training in General Practice on seminar days of the Competence Centre for General Practice Saxony-Anhalt for an immediate answer. Results: Of the 109 doctors, 73 completed the questionnaire. A general high relevance of the topic HIV was stated by 95%. In contrast, 71% said it was relevant for family doctor activities. The knowledge questions on the prevalence were answered correctly for all questions with less than 40%; 21% stated that they knew the indication prerequisite for a PEP; 49% answered the question about the period of the highest efficacy of PEP correctly. PrEP as a drug option for prophylaxis is known to a part of the respondents, 79% would prescribe PrEP, 69% were in favour of a health insurance benefit. Discussion: The results show that the necessary basic knowledge about HIV is partly available. Basic knowledge on structured action in the fields of HIV testing, PEP and PrEP should be taught in a manner appropriate to the relevance of the topic in the context of the German general practice setting. Even a basic knowledge about PEP may help to ensure that the general practice teams receive proper measures after a possible exposition.

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