Acute HIV at the Time of Initiation of Pre-exposure or Post-exposure Prophylaxis: Impact on Drug Resistance and Clinical Outcomes
Acute HIV at the Time of Initiation of Pre-exposure or Post-exposure Prophylaxis: Impact on Drug Resistance and Clinical Outcomes
复制标题
DOI：
10.1097/qai.0000000000002638
复制
发表时间：
2021-06-01
影响因子：
3.6
通讯作者：
Cohen, Stephanie E.
中科院分区：
文献类型：
--
作者：
Johnson, Kelly A.;Chen, Miao-Jung;Cohen, Stephanie E.
背景：在未确诊的急性HIV(AHI)环境中启动暴露前或暴露后预防(PrEP/PEP)可能会导致抗逆转录病毒耐药。我们试图在旧金山市的一家性传播疾病诊所研究服用PrEP/PEP的未确诊AHI患者的临床结果和耐药性突变。背景：在我们的PrEP/PEP计划中，患者使用护理点抗体测试进行HIV检测。如果阴性，患者将开始预防，并使用汇集的HIV RNA进行AHI筛查(5-10天好转)。结果：在1758例PrEP和2242例PEP中，PrEP使用者中有7例(0.40%)，PEP使用者中有6例(0.30%)。与艾滋病毒护理、开始艾滋病毒治疗和病毒抑制相关的中位时间分别为7天、12天和43天。在开始艾滋病毒护理时，3名患者(23%)在开始PrEP/PEP后7-12天发现M184突变。从PrEP/PEP启动之日起，所有3人都对储存的血清进行了基因分型，每一份都证实了野生型病毒。所有3名患者都获得了持久的病毒抑制。
Background: Initiating pre-exposure or post-exposure prophylaxis (PrEP/PEP) in the setting of undiagnosed acute HIV (AHI) could cause antiretroviral resistance. We sought to characterize clinical outcomes and drug resistance mutations among individuals prescribed PrEP/PEP with undiagnosed AHI at a San Francisco sexually transmitted disease clinic.Setting: In our PrEP/PEP program, patients are tested for HIV using a point-of-care antibody test. If negative, patients are started on prophylaxis and screened for AHI using pooled HIV RNA (5-10 days turn-around). We used 2-drug PEP until 05/2016.Methods: We identified patients who had as-yet-undiagnosed AHI on the day of PrEP/PEP start between 2011 and 2018, then used our clinical record and surveillance data to describe HIV resistance and clinical outcomes.Results: Of 1758 PrEP and 2242 PEP starts, there were 7 AHI cases among PrEP users (0.40%) and 6 among PEP users (0.30%). Median times for linkage to HIV care, initiation of HIV treatment, and viral suppression were 7, 12, and 43 days. On initiation of HIV care, 3 patients (23%) were found to have an M184 mutation 7-12 days after starting PrEP/PEP. All 3 had genotyping performed on stored serum available from the date of PrEP/PEP start, each of which demonstrated wild-type virus. All 3 patients achieved durable viral suppression.Conclusions: Although rare (occurring