Low HIV drug resistance prevalence among recently diagnosed HIV‐positive men who have sex with men in a setting of high PrEP use

• Published in: Journal of the International AIDS Society Vol. 27; no. 7; pp. e26308 - n/a
• Main Authors: King, Jonathan M, Giallonardo, Francesca Di, Shaik, Ansari, McGregor, Skye, Yeung, Julie Yuek Kee, Sivaruban, Tharshini, Lee, Frederick J, Cunningham, Philip, Dwyer, Dominic E, Nigro, Steven J, Grulich, Andrew E, Kelleher, Anthony D
• Format: Journal Article
• Language: English
• Published: Switzerland John Wiley & Sons, Inc 01.07.2024; John Wiley and Sons Inc; Wiley
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; ARV; Bisexuality; DNA polymerases; Drug resistance; Drug Resistance, Viral; Drug therapy; Emtricitabine; Emtricitabine - therapeutic use; Genomics; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV Infections - drug therapy; HIV Infections - epidemiology; HIV prevention; HIV-1 - drug effects; HIV-1 - genetics; Homosexuality, Male - statistics & numerical data; Human immunodeficiency virus; Humans; Laboratories; Lamivudine - therapeutic use; Male; men who have sex with men; Middle Aged; Mutation; New South Wales - epidemiology; Pre-Exposure Prophylaxis; Prevalence; Prophylaxis; Research ethics; Sexually transmitted diseases; Short Report; STD; Surveillance; Tenofovir - therapeutic use; treatment; Young Adult; New South Wales; Australia; pre‐exposure prophylaxis; treatment; HIV prevention; drug resistance; ARV; men who have sex with men
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.26308

Introduction New South Wales (NSW) has one of the world's highest uptake rates of HIV pre‐exposure prophylaxis (PrEP). This uptake has been credited with sharp declines in HIV transmission, particularly among Australian‐born gay and bisexual men. Concerns have been raised around the potential for the emergence of tenofovir (TFV) and XTC (lamivudine/emtricitabine) resistance in settings of high PrEP use. Such an emergence could also increase treatment failure and associated clinical outcomes among people living with HIV (PLHIV). Despite low levels of nucleoside reverse‐transcriptase inhibitor (NRTI) resistance relating to PrEP use in clinical settings, there are few published studies describing the prevalence of NRTI resistance among people newly diagnosed with HIV in a setting of high PrEP use. Methods Using HIV antiretroviral drug resistance data linked to NSW HIV notifications records of people diagnosed from 1 January 2015 to 31 December 2021 and with HIV attributed to male‐to‐male sex, we described trends in TFV and XTC resistance. Resistance was identified using the Stanford HIV Drug Resistance genotypic resistance interpretation system. To focus on transmitted drug resistance, resistance prevalence estimates were generated using sequences taken less than 3 months post‐HIV diagnosis. These estimates were stratified by timing of sequencing relative to the date of diagnosis, year of sequencing, birthplace, likely place of HIV acquisition, and stage of HIV at diagnosis. Results Among 1119 diagnoses linked to HIV genomes sequenced less than 3 months following diagnosis, overall XTC resistance prevalence was 1.3%. Between 2015 and 2021, XTC resistance fluctuated between 0.5% to 2.9% and was 1.0% in 2021. No TFV resistance was found over the study period in any of the sequences analysed. Higher XTC resistance prevalence was observed among people with newly acquired HIV (evidence of HIV acquisition in the 12 months prior to diagnosis; 2.9%, p = 0.008). Conclusions In this Australian setting, TFV and XTC resistance prevalence in new HIV diagnoses remained low. Our findings offer further evidence for the safe scale‐up of PrEP in high‐income settings, without jeopardizing the treatment of those living with HIV.