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.

Josh.