56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust.
MRC Clinical Trials Unit at UCL, London, UK.
AIDS. 2022 Mar 15;36(4):561-566. doi: 10.1097/QAD.0000000000003143.
Preexposure prophylaxis (PrEP) is contributing to achieve a reduction in HIV diagnoses in men having sex with men (MSM). Albeit infrequent, HIV infections in the context of recent PrEP exposure represent a clinical challenge.
Data on recent PrEP use and possible reasons leading to HIV infection were analysed in individuals newly diagnosed with HIV at 56 Dean Street clinic in 2016-2020. Demographics, immune-virological parameters, genotypic resistance test results and treatment management in this group were compared with those not reporting recent PrEP exposure using Mann-Whitney U test and Fisher's exact test.
Fifty-two of 1030 (5%) individuals reported recent PrEP exposure at HIV diagnosis; 98% were MSM, median age 34 years (interquartile range [IQR] 28-42), 65% of white ethnicity, 65% non-UK-born. 35% reported PrEP intake the day before testing HIV positive, 46% reported sub-optimal PrEP adherence since their last negative HIV test result. Thirty-three of 52 (63%) were self-sourcing PrEP and 9/52 (17%) reported issues with its supply. Recent PrEP use was associated to lower HIV viral load and higher CD4+ cell count at baseline than in counterparts non-recently exposed to PrEP (P < 0.01). M184V mutation was harboured more commonly in the recent PrEP use group (30% vs. 1%, P < 0.01). The proportion of individuals recently exposed to PrEP among those diagnosed with HIV rose sharply, reaching 21% in the first semester of 2020. Viral suppression was achieved by all patients intensified from PrEP to antiretroviral treatment (ART) who remained in care at week 24.
Rapid PrEP intensification to ART allowed to achieve high rates of HIV viral suppression despite significant rates of M184V mutation harboured in those newly diagnosed with HIV and reporting recent PrEP exposure.
暴露前预防（PrEP）有助于减少男男性行为者（MSM）中的 HIV 诊断。尽管不常见，但在最近接触 PrEP 的情况下发生的 HIV 感染仍然是一个临床挑战。
在 2016 年至 2020 年期间，对在 56 号Dean 街诊所新诊断出 HIV 的个体进行了最近使用 PrEP 和可能导致 HIV 感染的原因分析。使用 Mann-Whitney U 检验和 Fisher 确切检验比较了报告近期 PrEP 暴露和未报告近期 PrEP 暴露的个体的人口统计学、免疫病毒学参数、基因型耐药检测结果和治疗管理。
在 1030 名个体中，有 52 名（5%）报告在 HIV 诊断时最近接触过 PrEP；98%为 MSM，中位年龄 34 岁（四分位间距 [IQR] 28-42），65%为白人，65%非英国出生。35%的人在检测 HIV 阳性前一天服用 PrEP，46%的人自上次 HIV 检测阴性以来未按规定服用 PrEP。52 人中 33 人（63%）自行购买 PrEP，9/52 人（17%）报告 PrEP 供应存在问题。与最近未接触过 PrEP 的个体相比，最近接触 PrEP 的个体基线时 HIV 病毒载量和 CD4+细胞计数较低（P<0.01）。M184V 突变在最近接触 PrEP 的个体中更为常见（30% vs. 1%，P<0.01）。2020 年上半年，HIV 确诊患者中最近接触 PrEP 的比例急剧上升，达到 21%。所有从 PrEP 强化到抗逆转录病毒治疗（ART）的患者均实现了病毒抑制，并且在第 24 周时仍在接受治疗。
尽管最近接触 PrEP 并报告 HIV 感染的个体中携带 M184V 突变的比例较高，但通过迅速将 PrEP 强化到 ART，实现了较高的 HIV 病毒抑制率。
