Importance of early identification of PrEP breakthrough infections in a generalized HIV epidemic: a case report from a PrEP demonstration project in South Africa

Autor: Leila E. Mansoor, David Matten, Cherise L. Naicker, Denzhe Singo, Quarraisha Abdool Karim, Kogieleum Naidoo, Halima Dawood, Carolyn Williamson
Rok vydání: 2020
Předmět:
Cyclopropanes
0301 basic medicine
Pediatrics
Administration
Oral
Case Report
Pre-exposure prophylaxis (PrEP)
Fourth-generation rapid tests for HIV screening
PrEP breakthrough infections in HIV-endemic settings
law.invention
South Africa
0302 clinical medicine
Medical microbiology
law
HIV Seropositivity
030212 general & internal medicine
Emtricitabine
Tenofovir Disoproxil Fumarate Drug Combination
virus diseases
Viral Load
Resistance mutation
Drug Combinations
Treatment Outcome
Infectious Diseases
Lamivudine
Alkynes
Female
Zidovudine
Viral load
HIV drug resistance
medicine.drug
medicine.medical_specialty
Anti-HIV Agents
HIV prevention
Emtricitabine
lcsh:Infectious and parasitic diseases
Young Adult
03 medical and health sciences
Condom
Drug Resistance
Viral
medicine
Humans
lcsh:RC109-216
Epidemics
Tenofovir
Retrospective Studies
business.industry
030112 virology
Benzoxazines
Discontinuation
Regimen
HIV-1
Pre-Exposure Prophylaxis
business
Zdroj: BMC Infectious Diseases, Vol 20, Iss 1, Pp 1-6 (2020)
BMC Infectious Diseases
ISSN: 1471-2334
DOI: 10.1186/s12879-020-05255-5
Popis: Background The World Health Organisation recommends the use of tenofovir-containing pre-exposure prophylaxis (PrEP) as an additional Human Immunodeficiency Virus (HIV) prevention choice for men and women at substantial risk of HIV infection. PrEP could fill an important HIV prevention gap, especially for sexually active young women who are limited in their ability to negotiate mutual monogamy or condom use. As PrEP is scaled up in high HIV incidence settings, it is crucial to consider the importance of early identification of HIV infection during PrEP use, to allow for rapid discontinuation of PrEP to reduce the risk of antiretroviral (ARV) resistance. The purpose of this case study is to provide this critical evidence. Case presentation This report describes a 20-year-old woman in a HIV sero-discordant relationship who initiated oral PrEP (tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC)) through a demonstration project (CAPRISA 084) in October 2017. Despite good adherence throughout her PrEP use, she tested HIV antibody positive at month nine of study participation. Retrospective testing showed increasing HIV viral load over time, and retrospective use of fourth-generation rapid HIV tests showed HIV detection (positive antigen/antibody) at month one. Sequencing confirmed a dominant wild type at month one with dual therapy resistance patterns emerging by month three (M184V and K65R mutations), which is suggestive of protracted PrEP use during an undetected HIV infection. The participant was referred to infectious diseases for further management of her HIV infection and was initiated on a first line, tenofovir-sparing regimen. At the time of this report (January 2020), the participant had been on ARV- therapy (ART) for 13 months and had no signs of either clinical, immunologic or virologic failure. Conclusions This case report highlights the importance of appropriate HIV screening during wider oral PrEP scale-up in high HIV incidence settings to circumvent the consequences of prolonged dual therapy in an undiagnosed HIV infection and in turn prevent ARV resistance.
Databáze: OpenAIRE
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