Are current guidelines adapted for patient eligibility to PrEP? A case report

Area of Science:

• Infectious Diseases
• Virology
• Public Health

Background:

• HIV infection remains a global health challenge despite effective antiretroviral therapy.
• Pre-exposure prophylaxis (PrEP) significantly reduces HIV risk in high-risk populations.
• Uncertainties surround PrEP, including adverse events, resistance, and resurgence of other infections.

Observation:

• A 52-year-old MSM, eligible for PrEP due to high HIV risk and seronegativity, initiated treatment with emtricitabine-tenofovir disoproxil.
• Despite perfect compliance, the patient tested HIV-positive one month later, with retrospective analysis revealing detectable HIV RNA before PrEP initiation.
• Genotyping showed the virus developed resistance to lamivudine and emtricitabine after one month of PrEP.

Findings:

• Current PrEP guidelines may not adequately screen for recently infected but still seronegative individuals.
• Undetected early HIV infection at PrEP initiation can lead to treatment failure and drug resistance.
• This case highlights potential gaps in PrEP eligibility screening protocols.

Implications:

• Improved screening, including plasma viral HIV RNA testing before PrEP initiation, is crucial for at-risk individuals.
• Inadequate screening can lead to treatment failure, drug resistance, and potential transmission to partners.
• Enhanced selection criteria for PrEP eligibility are necessary to minimize infection risks and prevent viral mutations.