Q and A

Question

Will PEP still work with resistant HIV?

26 April 2023. Related: Access to treatment, Adherence, All topics, PEP/PEPSE, Resistance.

PEP and HIV resistance.

HIV in my country has more than 10% of resistance to tenofovir and lamivudine, a high number, according to WHO, but the PEP offered here has dolutegravir, tenofovir and lamivudine.

Is dolutegravir enough to prevent the HIV infection through PEP if the virus that I was exposed to is resistant to tenofovir and lamivudine?

And if this is the first line treatment, what will happen if this treatment fails? A treatment with second or even third line drugs?

Answer

Answer: Josh Peasegood

Hi, how are you doing?

10% is a high level of resistance. But it still means that 90% of HIV in Brazil is not resistant.

This 10% is also not resistant to dolutegravir. This is why triple combination drugs are used. Even in the case of resistance to tenofovir and lamviduine, the presence of dolutegravir will allow PEP to continue to work.

PEP is given on the basis of what is available in the country and the cost of treatment. TLD is first line as it is easily accessible and is not en expensive treatment. The most common reasons for PEP to fail is people not taking it properly or stop the course early. It is rarely because HIV is resistant to all drugs used within the PEP combination.

If using TLD as PEP was to fail and resistance testing was done to check that it is because of a resistant strain. Second and third line combinations can be used to treat HIV. Again this is based on WHO guidelines but is determined by what the country has access to.

Please see this link for more information about PEP:
https://i-base.info/qa/factsheets/pep-faq

Josh.

16 comments

  1. Simon Collins •

    Hi Komane, how is your new girlfriend doing? How has she taken this news?

    Does she have access to treatment?

    Has the clinic given her CD4 and viral load test results?

  2. Komane •

    Hi HIV base team

    I trust you are all in good health.

    On the 30th July 2024 I took double dose of Acriptega (TLD) 1hour 41 minutes before unprotected Sex,After we had unprotected sex with my new girlfriend, we bought home test kits to test and her test came out HIV-1 positive and I was negative and I took a third dose same day maybe after 6 hours. so I continued with the Acriptega, I take single dose same time everyday at the same time of the first double dose.

    now I’m on day 13 taking PEP after the exposure as I believe it was a high risk exposure as she was not on medication. Is the PEP going to work or be effective or since I took it 1h41 minutes it could have worked as a On-demand PREP.

    I would appreciate your feedback and information.

  3. Simon Collins •

    Please see this info on PEP, including the flexibility for timing:
    https://i-base.info/qa/factsheets/pep-faq

  4. Thabang •

    I miss my pep by 58 min and this is my 19 day…but i usually take my pep at 20:00 so i was 58 minutes late is it going to be effective?

  5. Simon Collins •

    Hi Kiri, thanks, please don’t worry about being a little early or late. There is a window of a few hours that will all be okay. Pls see this link for more info:
    https://i-base.info/qa/factsheets/pep-faq

  6. Kiri •

    Hi am taking pep TLD but like for a week I have been taking it like some minutes late …do you think it will work