Does PrEP For HIV Lead To Drug Resistance?

An interesting article in AIDSMap has shown that if a person was to become infected with HIV while taking PrEP, a daily medication to prevent HIV infection) that drug resistance markers  rapidly decayed.

“PrEP-selected resistance decays rapidly after PrEP cessation,” comment the investigators. “By six months after seroconversion (after PrEP was discontinued), resistance mutations K65R, K70E and/or M184IV that were present at seroconversion were no longer detected, even with highly sensitive resistance testing.”

The investigators call for future studies to examine whether PrEP-associated resistance affects subsequent response to treatment.

This is reassuring news as it has been a strong concern for some doctors as its felt that effective HIV treatment needs 3 potent drugs and that given there are only two in PrEP there is increased risk of HIV drug resistance developing.

The key points to note here is are that starting PrEP when a person is already infected with HIV is quite rare and usually quickly picked up.

In my own practice I insist that people get a 4th generation rapid HIV test before starting their first dose of PrEP to greatly reduce this risk.

With PrEP becoming more important a technology is HIV prevention we will certainly be learning more as new evidence evolves.

Dr George Forgan-Smith

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