{"id":41912,"date":"2021-12-20T07:36:08","date_gmt":"2021-12-20T07:36:08","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=41912"},"modified":"2022-02-10T11:32:53","modified_gmt":"2022-02-10T11:32:53","slug":"56-dean-streat-reports-7-hiv-transmissions-on-prep-despite-excellent-adherence-m184v-also-commonly-reported-with-recent-low-adherence","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/41912","title":{"rendered":"56 Dean Street reports M184V common with recent low adherence to PrEP and seven transmissions with good adherence"},"content":{"rendered":"
Simon Collins, HIV i-Base<\/span><\/strong><\/div>\n
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Although PrEP is highly effective at preventing HIV, a recent report from 56 Dean Street Clinic in central London included seven cases of HIV transmission with self-reported good adherence. Also, that there is a risk of developing drug resistance if adherence to PrEP is low. [1]<\/strong><\/p>\n<\/div>\n

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Of 1030 HIV diagnoses between 2016 and 2020, roughly 5% (n=52) reported recent PrEP use. Of these, 98% were gay or bisexual men, with median age 34 (IQR: 28 to 42), 65% white and 65% non-UK-born. <\/span><\/p>\n<\/div>\n

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PrEP use was reported by 35% on the day before diagnosis with 46% reporting intermittent adherence. Of these, 11\/24 were using daily PrEP and 13\/24 were using 2:1:1 dosing. Supply\/access difficulties were reported by 9\/52 (17%). <\/span><\/p>\n<\/div>\n

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Other reasons included: \u201c5\/52 (10%) interrupted PrEP after starting a monogamous relationship, 3\/52 (6%) did not plan to have sex, 3\/52 (6%) chose to interrupt PrEP and 1\/52 (2%) was taking an antiretroviral regimen not licensed for PrEP (raltegravir)\u201d.<\/span><\/p>\n<\/div>\n

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However, reasons for PrEP failure could not be explained in 7\/52 (13%) who reported excellent adherence (though drug levels were not available). Of these 2\/7 had the M184V mutation on diagnosis that might indicate infection after exposure to drug-resistant HIV.<\/span><\/p>\n

Delayed HIV seroconversion and\/or unrecognised HIV infection when starting PrEP could be a factor in\u00a05\/7 cases who were sourcing PrEP online, and the median time since their last HIV negative test was 124 days. HIV was then detected with the first clinic test.<\/p>\n<\/div>\n

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The M184V mutation was more common in the recent\u00a0PrEP\u00a0use group (30% vs 1%,\u00a0p<0.01). PrEP use also increased over time, reaching 20% by 2020.<\/span><\/p>\n<\/div>\n

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The paper reported that all people who intensified from\u00a0PrEP\u00a0to ART achieved an undetectable viral load at week 24. ART was tenofovir-based, with the third drug boosted-darunavir (n=28), bictegravir (n=8), dolutegravir (n=7) or raltegravir (n=4). The clinic protocol includes switching from darunavir to integrase inhibitors three months from ART initiation, but this only occurred in 14\/28 participants.<\/span><\/p>\n<\/div>\n

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comment<\/span><\/h3>\n<\/div>\n
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Although the short-term response to intensified ART is important, longer follow-up is really needed to show a durable response to ART in case of suboptimal ART due to M184V.<\/span><\/strong><\/p>\n<\/div>\n

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Access to PrEP at 56 Dean Street is impressive: the clinic recently reported prescribing PrEP on the NHS to more than 25,000 people since 2020. [2]<\/strong><\/p>\n

Also, while the primary analysis focussed on M184V resistance, the otherwise unexplained cases of HIV acquisition in the context good adherence are important enough to deserve a more detailed analysis.<\/strong><\/p>\n<\/div>\n

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References<\/span><\/p>\n<\/div>\n

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  1. Girometti N et al. Rising rates of recent\u00a0PrEP\u00a0exposure among MSM newly diagnosed with HIV: antiviral resistance patterns and treatment outcomes. AIDS, doi: 10.1097\/QAD.0000000000003143.
    \n<\/span>https:\/\/journals.lww.com\/aidsonline\/Abstract\/9000\/Rising_rates_of_recent_PrEP_exposure_among_MSM.96256.aspx<\/a><\/li>\n
  2. Dean Street press release. HIV PrEP awareness week: 29th November \u2013 5th December.
    \n    https:\/\/www.dean.st\/prep<\/a><\/li>\n<\/ol>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Although PrEP is highly effective at preventing HIV, a recent report from 56 Dean Street Clinic in central London included seven cases of HIV transmission with self-reported good adherence. Also, that there is a risk of …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[],"class_list":["post-41912","post","type-post","status-publish","format-standard","hentry","category-transmission-and-prevention"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/41912","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=41912"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/41912\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=41912"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=41912"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=41912"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}