History of PrEP use linked to M184I/V mutation at HIV diagnosis

Among individuals newly infected with HIV, the presence of an M184I/V mutation at baseline is more prevalent among those with a history of pre-exposure prophylaxis (PrEP) use. These findings were published in Clinical Infectious Diseases.

Although PrEP is highly effective as an HIV prevention strategy, there is concern that its use in the period prior to HIV diagnosis may be associated with increased risk for acquired drug resistance.

To evaluate evidence on drug resistance related to PrEP use, researchers examined individuals (N=4246) who were newly diagnosed with HIV infection between 2015 and 2022 and included in the New York City HIV Surveillance Registry. The prevalence of M184I/V mutations in this population were assessed within 30 days of HIV diagnosis and evaluated on the basis of PrEP use history. Recent PrEP use was defined as initiation or discontinuation of PrEP within 90 days of diagnosis; past PrEP use was defined as discontinuation of PrEP at least 90 days before diagnosis.

Among patients included in the study, 79% were men, 62% were aged 30 years and older, 41% were Black, 61% were infected with HIV via male-to-male sexual contact, and 13% had acute infection at HIV diagnosis.

In regard to PrEP use history, 136 patients reported recent use, 124 reported past use, and 3986 reported no history of use.

All baseline sociodemographic characteristics in this population differed significantly on the basis of PrEP use history (all P £.01). Moreover, acute HIV infection was more common among patients who reported recent PrEP use (30%) than those who reported past (19%) or no history (12%) of PrEP use (P <.0001).

At baseline, M184I/V mutations were present among 2% of the population. A M184I/V mutation was significantly more prevalent among patients who reported recent or past PrEP use than in those with no history of use (14% and 8% vs 2%, respectively; P <.0001). The mutation was also significantly more prevalent among patients who acquired HIV infection via male-to-male sexual contact vs other transmission routes (3% vs 1%; P =.002), and among individuals with vs without acute infection (4% vs 2%; P =.02).

Among patients with acute HIV infection, the presence of an M184I/V mutation was associated with recent vs no known PrEP use (adjusted relative risk [aRR], 5.86; 95% CI, 2.49-13.77). For patients without acute infection, the mutation was associated with both recent (aRR, 7.26; 95% CI, 3.98-13.24) and past PrEP use (aRR, 4.46; 95% CI, 2.15-9.24) relative to no known use.

This study may be limited as patients who were not assessed for the presence of an M184I/V mutation within 30 days of HIV diagnosis were excluded, which reduced the sample size by more than half.

The researchers concluded, “We found a strong association between PrEP use and the presence of drug resistance at diagnosis in NYC, a setting of high HIV prevalence…”

By Jessica Nye, PhD

References:

Misra K, Huang JS, Udeagu C-CN, Forgione L, Xia Q, Torian LV. Pre-exposure prophylaxis (prep) use history in people with antiretroviral resistance at HIV diagnosis: findings from New York City HIV surveillance and partner services, 2015-2022. Clin Infect Dis. Published online November 17, 2023. doi:10.1093/cid/ciad699