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Handbook of Antimicrobial Resistance pp 479–498Cite as

HIV-1 Drug Resistance in Pre-exposure Prophylaxis Trials

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Abstract

When used with other proven strategies for prevention of HIV-1 acquisition, oral and topical preexposure prophylaxis (PrEP) has been shown to be effective in multiple randomized, placebo-controlled clinical trials throughout the world. Preexposure prophylaxis trials have included over 20,000 men and women at risk for HIV infection through sexual or intravenous exposure. A consistent finding is that drug exposure is essential for PrEP efficacy. In PrEP users with breakthrough infection, selection of drug-resistant virus is a possible outcome, presenting a unique sequence of events and outcomes compared with therapeutic use of antiretroviral drugs. Study findings have indicated that drug resistance selected by PrEP occurs rarely, except in cases where PrEP is initiated in very early infection, prior to seroconversion, and detectable only with nucleic acid tests. In this review, we discuss the factors associated with PrEP which may contribute to drug resistance and summarize the frequency and characteristics of HIV-1 drug resistance reported to date from global clinical trials. A theoretical framework of the causes and consequences of drug resistance in PrEP is considered as a basis of the real-life outcomes and challenges in implementing PrEP.

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Authors and Affiliations

  1. Department of Medicine, University of California, San Francisco, CA, USA

    Teri Liegler & Robert Grant

  2. Gladstone Institute of Virology and Immunology, San Francisco, CA, USA

    Robert Grant

  3. San Francisco AIDS Foundation, San Francisco, CA, USA

    Robert Grant

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  1. Teri Liegler
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  2. Robert Grant
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Correspondence to Teri Liegler .

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Editors and Affiliations

  1. Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada

    Albert Berghuis

  2. Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada

    Greg Matlashewski

  3. Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada

    Mark A. Wainberg

  4. Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada

    Donald Sheppard

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Liegler, T., Grant, R. (2017). HIV-1 Drug Resistance in Pre-exposure Prophylaxis Trials. In: Berghuis, A., Matlashewski, G., Wainberg, M., Sheppard, D. (eds) Handbook of Antimicrobial Resistance. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0694-9_24

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