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Seroconversion on preexposure prophylaxis: a case report with segmental hair analysis for timed adherence
Joshua T Thaden1, Monica Gandhi2, Hideaki Okochi2
1Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina.
AIDS (London, England)
|April 24, 2018
Summary
This case report details a multidrug-resistant HIV infection despite consistent pre-exposure prophylaxis (PrEP) adherence. Hair analysis confirmed high drug levels, suggesting MDR-HIV as the likely cause of seroconversion.
Area of Science:
- Infectious Diseases
- Virology
- Pharmacology
Background:
- Pre-exposure prophylaxis (PrEP) with emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) is highly effective in preventing HIV acquisition.
- However, cases of HIV seroconversion despite PrEP raise concerns about drug resistance and adherence.
- Multidrug-resistant (MDR)-HIV presents a significant challenge in treatment and prevention strategies.
Observation:
- A 34-year-old man on daily FTC/TDF PrEP experienced HIV seroconversion.
- Genotyping revealed mutations associated with multidrug resistance (M184V, K70T, K65R, K103N).
- Plasma drug concentrations indicated recent and consistent PrEP dosing.
Findings:
- Segmental hair analysis, a novel method in this context, demonstrated consistently high levels of FTC and tenofovir (TFV) over the preceding three months.
- These drug levels were commensurate with high adherence to daily PrEP.
- The findings strongly suggest that the HIV infection was acquired during the period of high adherence, leading to a multidrug-resistant strain.
Implications:
- This case highlights the possibility of HIV seroconversion with multidrug-resistant strains even with documented high PrEP adherence.
- Accurate assessment of PrEP adherence, including through novel methods like hair analysis, is crucial when evaluating PrEP failures.
- Ensuring best practices in PrEP prescribing, monitoring, and follow-up is essential to optimize HIV prevention efforts.
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