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Evaluating the extent of potential resistance to pre‐exposure prophylaxis within the UK HIV ‐1‐infectious population of men who have sex with men
Author(s) -
Dolling D,
Phillips AN,
Delpech V,
Pillay D,
Cane PA,
Crook AM,
Shepherd J,
Fearnhill E,
Hill T,
Dunn D
Publication year - 2012
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2011.00968.x
Subject(s) - medicine , pre exposure prophylaxis , emtricitabine , men who have sex with men , population , human immunodeficiency virus (hiv) , logistic regression , hiv drug resistance , demography , drug resistance , viral load , antiretroviral therapy , virology , environmental health , syphilis , sociology , microbiology and biotechnology , biology
Objectives Recent studies have shown that pre‐exposure prophylaxis ( PrEP ) can substantially reduce the chance of acquiring HIV infection. However, PrEP efficacy has been found to be compromised in macaque studies if the challenge virus is antiretroviral therapy ( ART )‐resistant. Our objective was to evaluate the likelihood that a UK man who has sex with men ( MSM ) would be exposed to PrEP ‐resistant HIV in a homosexual encounter with an HIV ‐infectious partner. Methods Data from the UK C ollaborative HIV C ohort ( UK CHIC ) study were linked to the UK HIV D rug R esistance D atabase for HIV ‐1‐positive MSM patients seen between 2005 and 2008. Patients were categorized as undiagnosed; diagnosed but ART ‐naïve; ART ‐experienced and on treatment; and ART ‐experienced and on a treatment interruption. Considering current PrEP regimens, resistance to (a) tenofovir ( TDF ) alone, (b) TDF and emtricitabine ( FTC ), and (c) TDF or FTC was estimated. Patients without resistance tests had PrEP resistance imputed using bootstrapping and logistic regression models. Results The population‐level prevalence of PrEP resistance in HIV ‐infectious individuals in 2008 was estimated to be 1.6, 0.9 and 4.1% for PrEP resistance definitions a, b and c, respectively. Prevalence in ART ‐experienced patients was highest, with negligible circulating resistance amongst ART ‐naïve individuals. The levels of resistance declined over the period of study. Conclusions Our analysis indicates low levels of resistance to proposed PrEP drugs. The estimated PrEP resistance prevalence in UK HIV ‐infected MSM is towards the lower range of values used in simulation studies which have suggested that circulating PrEP drug resistance will have a negligible impact on PrEP efficacy at the population level.